,-^,-„,,HEBHBESIONAL, 


000  005  729     9 


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Bought  of 


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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


Gift   of 
ur.   \'i.   L.    Grant 


■  L.  GRiifiir,  iw.  a 

FARGO,    N.  DAK. 


G>C^ 


A  HANDBOOK 


OF 


THERAPEUTICS 


BY 


SYDNEY  RINGER,  M.D. 

PROFESSOR    OF    THE     PRINCIPLES    AND     PRACTICE   OF   MEDICINE    IN    UNIVERSITY     COLLEGE, 
PHYSICIAN    TO    UNIVERSITY    COLLEGE   HOSPITAL 


^iwiftix  '^amon 


NEW  YORK 

WILLIAM    WOOD    AND    COMPANY 

56   &    58    LAFAYETTE   PLACE 

1889 


i 


Bismedical 
libiaiy 

300 

im 


PEEFACE  TO  THE    TWELFTH    EDITIOK 


As  ill  previous  editions,  so  with  this,  I  dwell  much  more  on  the 
indications  for  the  use  of  drugs  in  disease  than  on  their  physiological 
action.     The  book  is,  in  fact,  a  work  on  clinical  therapeutics. 

In  preparing  this  edition,  I  have  carefully  revised  every  portion, 
and  added  much  fresh  information,  not  only  on  new  drugs,  but  also 
on  old. 

I  am  anxious  again  to  express  my  great  obligation  to  my  friend, 
Dr.  George  Bird,  who  has  assisted  in  revising  this  and  several  previous 
editions  of  this  Handbook,  and  who  has  increased  its  usefulness  by 
many  suggestions. 

Octobei',  1888. 


6n.^rt.^4 


INTEODUCTIO:^'. 


I  HAVE  thought  it  might  prove  useful  to  the  student  and  to  the  young 
practitioner  to  insert  in  this  edition  a  brief  account  of  the  symptoms  of 
disease.  Of  late  years,  since  attention  has  been  more  drawn  to  the  signifi- 
cance of  physical  signs,  too  little  heed  seems  to  me  to  be  paid  to  the  detec- 
tion and  appreciation  of  symptoms,  objective  and  subjective.  This  is  a 
marked  defect  among  students.  One  often  meets  with  a  student, 
thoroughly  equipped  with  all  the  resources  pertaining  to  physical  diagnosis, 
who  yet  is  sorely  puzzled  with  the  indications  afforded  by  the  pulse  or 
tongue.  The  reason  is  obvious.  Physical  signs  are  soon  learned,  whilst 
it  requires  a  longer  time,  more  patience,  and  a  more  discriminating  obser- 
vation to  appreciate  the  meaning  and  to  estimate  the  value  of  symptoms. 

The  indications  of  disease  are  divided  into  symptoms  and  "  physical 
signs."  The  direct  information  to  be  obtained  from  the  pulse,  the  skin, 
the  tongue,  the  breathing,  the  evacuations,  etc. ,  are  for  convenience,  termed 
objective  symptoms.  The  indirect  information  we  gather  from  the 
patient's  description  of  his  own  feelings  and  sensations,  which  are  detected 
only  by  the  patient  himself;  these,  likewise  for  the  purjiose  of  convenience, 
are  termed  subjective  symptoms.  Important  though  physical  signs  un- 
doubtedly are,  yet  symptoms,  especially  objective  symptoms,  are  far  more 
valuable.  Physical  signs,  as  a  rule,  help  us  to  detect  only  coarse  and  de- 
cided changes,  and  are  chiefly  useful  in  diagnosis,  whilst  symptoms  are  far 
more  useful  guides  in  prognosis  and  in  treatment. 

It  may  be  said,  that  before  we  can  efficiently  treat  a  patient,  we  must 
first  form  a  correct  diagnosis;  hence  physical  signs,  by  greatly  assisting  us 
in  this  respect,  must  likewise  greatly  aid  in  the  treatment.  In  some  measure, 
this  proposition  is  no  doubt  true;  but  when  we  have  accurately  diagnosed 
the  disease,  we  treat,  in  most  cases,  the  secondary  effects  rather  than  the 
primary  disease;  and  these  secondary  effects  generally  make  themselves 
apparent  solely  as  symptoms.  Only  in  a  few  instances,  as  ague  and  syphi- 
lis, can  we  directly  cure  the  disease  itself;  but  in  other  instances  we  must 
be  content  to  combat  the  secondary  and  often  fatal  effects.  A  disease 
often  neither  endangers  nor  destroys  life  by  its  direct  effect  on  the  organ 
attacked,  but  through  a  secondary  effect  manifested  on  another  organ  or 
organs.  Thus  to  take  the  case  of  pneumonia;  here,  by  no  means  unfre- 
quently,  the  dangers  depend,  not  on  the  condition  of  the  lung,  but  on 
nervous  or  cardiac  depression.     The  fever  depresses  the  nervous  system, 

V 


VI  INTRODUCTIOJ^. 

shown  in  sleeplessness  and  delirium,  and  this  depressed  state  of  the 
nervous  system  causes  cardiac  weakness  and  so  endangers  and  destroys 
life;  or  the  fever  may  directly  depress  the  heart  and  so  weaken  it  that  the 
patient  dies.  Xow  in  both  these  instances,  the  effects  on  the  nervous 
system  and  on  the  heart  are  manifested  solely  by  symptoms,  and  without 
due  appreciation  of,  and  proper  attention  to  these  symptoms,  so  much 
the  worse  for  the  patient. 

Instances  like  this  might  be  multiplied  to  any  extent.  Moreover, 
there  is  the  wide  range  of  diseases  in  which  physical  diagnosis  is  unavail- 
ing and  when  there  are  only  symptoms  to  guide  our  treatment;  and  unless 
trained  in  the  recognition  and  estimation  of  symptoms,  these  are  just  the 
cases  in  which  the  young  practitioner  is  more  likely  to  find  himself  at  sea. 


CONTENTS. 


PAGE 

Introduction, v 

The  Tongue, 1 

The  Pulse, 4 

The  Skin, 15 

Tlie  Temperature  of  Health, 18 

Temperature  in  Disease, 18 

Abnormal  Elevation  of  Temperature,  or  Fever,  etc 19 

Chronic  Fever, 24 

On  Dropsy, 32 

The  Effects  of  Cold  on  the  Body, 35 

The  Cold  Bath,  including  Sea-Bathing,          . 38 

The  Sitz-Bath, 43 

On  Packing  with  the  Wet  Sheet, 44 

Cold  Baths  in  Fevers, 45 

The  Warm  Bath  and  the  Hot  Bath, 50 

Hot- Air  and  Vapor-Baths, 53 

Shower,  Douche,  and  Sponge  Baths, 54 

The  Turkish  Bath, 58 

Poultices  and  Fomentations, G2 

The  Medicinal  Uses  of  Ice, G7 

On  the  Spinal  Ice-Bag  and  the  Spinal  Hot-water  Bag,        ....  69 

The  Spinal  Hot-water  Bag, 71 

The  Internal  Use  of  Water, 71 

On  Enemata, 74 

On  Acupuncture, 77 

Irritation  and  Counter- Irritation, 81 

Carbon,  Animal  Charcoal,  Wood  Charcoal, 86 

Carbonic  Acid, 88 

Sulphur, 88 

The  Sulphide  of  Potassium,  Sodium,  Ammonium,  and  Calcium,       .         .  92 
Chlorine  Gas,  Chlorine  Water,  Chlorinated  Soda,  Chlorinated  Lime, 

and  their  Solutions, 98 

Iodine, 100 


Vlll  CONTENTS. 

PAGE 

A  few  Introductory  Remarks  regarding  the  Relative  Effects  of  Potas- 
sium and  Sodium  Salts, 104 

Iodide  of  Potassium,  Iodide  of  Sodium,  Iodide  of  Ainiuoniuiii,  .  .  107 
Bromide  of  Potassium,  Sodium,  Ammonium,  and  Lithium,  .  .  .114 
A  Theory  concerning  the  "  Topical "  Action  of  Acids  and  Alkalies  on 

Secretion, 123 

Sulphuric,  Hydrochloric,  Nitric,  Phosphoric,  and  Acetic  Acid,         .  123 

Sulphurous  Acid,  Sulphites,  Hyposulphites 130 

Chromic  Acid, 132 

Boric  or  Boracic  Acid, 133 

Group  embracing  Caustic  Potash,  Solution  of  Potash,  Carbonate  and 
Bicarbonate  of  Potash,  Acetate  of  Potash,  Citrate  of  Potash,  and 
the  corresponding  Preparations  of  Soda,  Potash  Soap,  Soda  Soap, 

Borax, 133 

Ammonia,  Carbonate  of  Ammonia,  Spirits  of  Ammonia,  ....  146 
Magnesia,  Light  Magnesia,  Carbonate  of  Magnesia,  Light  Carbonate  of 

Magnesia,  Solution  of  Carbonate  of  Magnesia, 150 

Lime,  Caustic  Lime,  Lime-water,  Liniment  of  Lime,  Saccharated  Solu- 
tion of  Lime,  Carbonate  of  Lime, 151 

Phosphate  of  Lime, 155 

Hypophosphite  of  Lime,  Hypophosphite  of  Soda, 158 

Chloride  of  Potassium,  Chloride  of  Sodium,  Chloride  of  Ammonium,  .  158 
Group  containing  Sulphate  of  Potash,  Sulphate  of  Soda,  Sulphate  of 

Magnesia,  Phosphate  of  Soda,  Tartrate  of  Potash,  Bitartrate  of  • 

Potash,  Tartrate  of  Potash  and  Soda, IGO 

Nitrate  of  Potash,  Nitrate  of  Soda, 165 

Chlorate  of  Potash, 168 

Alum,  Dried  Alum,  Acetate  of  Alumina, 169 

Preparations  of  Iron, 172 

Salts  of  Manganese, 178 

Nitrate  of  Bismuth,  Carbonate  of  Bismuth, 180 

Lead  Salts, 181 

Nitrate  of  Silver,  Oxide  of  Silver, 187 

Mercury  and  its  Preparations, 191 

Preparations  of  Copper, 206 

Preparations  of  Zinc, 207 

Preparations  of  Antimony, 210 

Preparations  of  Arsenic, 215 

Phosphorus, 232 

Collodion,     .        .        .        • 236 

Cod-Liver  Oil,  Almond   Oil,  Poppy   Oil,  Hemp-seed   Oil,  Linseed   Oil, 

Cocoa-Nut  Oil,  Dugong  Oil,  Palm  Oil,  Lard,  Suet,  Wax,  etc.,         .  237 


CONTENTS.  IX 

PAGE 

Castor  Oil,  Croton  Oil, 244 

Glycerine, 247 

Tannin  and  its  Compounds,  on  Gallic  Acid, 248 

Hanianielis  Virginica, 252 

Coto  Bark, 253 

Petrolevini,  Vaseline,  etc., 253 

Tar,  Creosote,  etc., 253 

Carbolic  Acid  and  Sulpho-Carbolates, 256 

Musk,  Castoreum 260 

Alcohol, 261 

Chloroform, 2G9 

Ether, 278 

Iodoform, 279 

lodol 281 

Hydrate  of  Chloral, 281 

Paraldehyde, 287 

Urethan 288 

Hydrate  of  Croton-Chloral, 288 

Nitrite  of  Amyl, 292 

Nitro-Glycerine, 298 

Nitrite  of  Sodium, 300 

Camphor, 301 

Turpentine,  Oil  of  Turpenthie, 303 

Group  containing  : — Nutmegs,  Cloves,  Canella  Bark,  Cinnamon  Bark, 
Cajeput  Oil,  Oil  of  Anise,  Fennel  Fruit,  Caraway  Fruit,  Coriander 
Fruit,  Dill  Fruit,  Elder  Flowei's,  Lavender  Oil,  Oil  of  Rosemary, 
Oil  of  Sandal  Wood,  Menthol,  Oil  of  Peppermint,  Oil  of  Spearmint, 
Oil  of  Rue,  Oil  of  Lemons,  Cubebs,  Buchu  Leaves,  Balsam  of  Tolu, 
Balsam  of  Peru,  Copaiba,  Mezereon,  Sassafras,  Storax,  Juniper, 

Benzoin,  etc., 306 

Eucalyptus, 309 

Valerian,  Valerianate  of  Zinc,  Valerianate  of  Quinia,  Valerianate  of 

Ammonia, 310 

Assafoetida,  Ammoniacum,  Galbanum, 310 

Cantharides, 311 

Mustard, 313 

Capsicum, 315 

Ipecacuanha  and  its  Preparations, 316 

Apomorphia ^ 327 

Veratrum  Viride.        .        .        .        .         .   _     .    ^ 327 

Veratria,       .        .        .        .   ^     .        .        .        . 328 

Colchicum,  ...        .....   ^     .        .        .  _ 330 


X  CONTENTS. 

PAGE 

Poilopliyllum, '^'•^■^ 

Guaiacuiii, ^'^6 

Actaea  (Ciiuicifuga)  Racemosa, 337 

Aconite, 338 

Digitalis  and  its  Preparations, 345 

Convallaria  Majalis, 357 

Strophanthus  (Kombi  Arrow  Poison), 357 

Spai'teine, 358 

Adonidin, 359 

Tobacco, 360 

Coniuni, 361 

Calabar  Bean, 365 

Muscarin, 368 

Jaborandi, 373 

Gelseniium  Sempervirens, 375 

Grindelia  Robusta, 382 

Belladonna, 383 

Ethyl- Atropium,  Methyl- Atropium, 400 

Hyoscyauius, 401 

Hyoscine, 402 

Stramonium, 403 

Duboisia  Myoporoides, 403 

Hydrocyanic  Acid,  Cyanide  of  Potassium, 404 

Opium, 405 

Nux  Vomica,  Strychnia,  Brucia,  Thebaia, 419 

Lobelia  Inflata, 426 

Cannabis  Indica, 427 

Ergot, 429 

Coffee,  Caffeine, 432 

Cocaine, 435 

Cinchona  and  its  Alkaloids, 441 

Salicine,  Salicylic  Acid,  SaUcylates, 448 

Salol, 452 

Antipyrine, 453 

Phenacetin, 455 

Quassia, 456 

Chamomile, 456 

Pareira  Brava, 456 

Elaterium, 457 

Colocynth, 457 

Aloes, 457 

Squill, 460 


J 


CONTENTS.  XI 

PAQE 

Jalap,  Scammony, 460 

Rhubarb, 461 

Senna 462 

Cascara  Sagrada, 462 

Euonyiuus, 462 

Senega, 463 

Anthelmintics  :  —  Filix  Mas,    Kousso,   Kamela,  Santonin,  Turpentine, 
Areea    ]N^ut,    Bark    of   the    Pomegranate   Root,    Powdered    Tin, 

Mueuna,  etc 463 

Dietary  for  Invalids, 467 

Index  to  Therapeutic  Agents, 479 

Index  to  Diseases, 


i 


A  HAND-BOOK  OF  THERAPEUTICS. 


THE    TONGUE. 


"We  examine  the  tongue  to  ascertain  whether  it  is  clean  or  furred;  dry 

or  moist;  its  color,  etc. 

What  is  the  meaning  of  a  furred  tongue  ? 

A  tongue  may  he  furred  from  febrile  disease;  from  local  causes;  or 
from  sympathy  with  the  stomach,  intestincB,  or  liver. 

The  condition  of  the  tongue  in  fever  is,  perhaps,  more  a  help  in  prog- 
nosis than  in  treatment.  In  most  fevers  the  tongue  at  first  is  covered 
with  a  moist  fur;  but  in  some  cases  the  tongue,  strange  to  say,  remains 
quite  clean.  Sometimes  this  is  the  case  in  typhoid  fever.  Now  the  coated 
tongue  in  fever  does  not  give  us  much  suggestion  with  regard  to  treatment, 
for  whether  the  tongue  is  clean  or  foul,  if  there  is  constipation  the  bowels 
must  be  relieved;  and  if  the  tongue  is  very  foul,  that  is,  thickly  coated,  a 
mercurial  purge  is  best,  though  whilst  the  fever  continues  some  fur  usually 
remains. 

Local  causes  often  foul  the  tongue.  Enlarged  tonsils  often  coat  the 
back  of  the  tongue.  Decayed  teeth  often  fur  a  portion  of  the  tongue. 
If  one  tonsil  only  is  enlarged,  or  if  the  decayed  teeth  are  situated  on  one 
side,  then  only  one  longitudinal  portion  of  the  tongue  is  furred.  In  neu- 
ralgia of  the  fifth,  when  the  lower  branches  are  affected,  the  tongue  on 
the  neuralgic  side  is  apt  to  become  furred. 

Excessive  smoking  almost  always  furs  the  tongue. 

The  tongue  very  frequently  indicates  derangement  of  the  stomach, 
bowels,  or  liver.  For  instance,  if  there  is  no  fever,  and  no  local  cause,  as  en- 
larged tonsils,  bad  teeth,  etc.,  then  a  coated  tongue  indicates  some  dis- 
turbance of  the  primge  via?. 

What  does  a  coated  tongue  under  these  circumstances  indicate  ?  We 
shall  rarely  go  wrong  in  taking  this  furred  tongue  as  an  indication  for 
giving  one  of  four  medicines,  or  some  of  them  combined :  namely,  mercury, 
podo})hyllin,  tincture  of  nux  vomica,  or  nitric  acid. 

How  are  we  to  determine  which  to  give  and  its  dose  ?  If  there  is  con- 
stipation then  give  a  mercurial  preparation  or  resin  of  podophyllin  in  pur- 
gative doses.  Any  purgative,  it  is  true,  will  here  be  useful,  especially  the 
natural  purgative  waters,  as  Pullna,  Friedrichshall,  or  Carlsbad;  but  these, 
though  valuable  remedies,  are  in  many  instances  inferior,  in  the  cases  in 
question,  to  mercurial  and  podophyllin  purges. 

As  regards  mercury,  our  choice  falls  either  on  calomel  or  blue  pill  for 
adults,  or  calomel  or  grey  powder  for  children.  The  calomel  or  blue  pill 
should  be  combined  with  extract  of  belladonna  or  of  hyoscyamus,  since 
this  addition  obviates  the  griping  and  certainly  seems  to  enhance  the  ac- 
tion of  these  drugs.     An  effective  dose  is  half  a  grain  of  calomel  with 

1 


iJ  THE   TOXGUE. 

three  grains  of  extract  of  liyoscyamus,  for  tlireo  consecutive  nights;  tlie 
first  pill  generally  purges  pretty  freely,  the  second  much  less  freely,  and 
the  tliird  scarcely  at  all,  though  it  helps  to  clean  the  tongue. 

Which  should  we  choose — mercurial  purges  or  podophylli.n  resin  ? 
The  answer  to  this  question  depends  on  the  color  of  the  stool.  If  the 
motions  are  too  light-colored  mercurial  purges  are  best.  If,  on  the  other 
hand,  the  motions  are  too  dark  then  podophyllin  is  needed.  For  this  clin- 
ical fac^t  I  can  give  no  explanation. 

What  is  to  bo  done  when  the  l)owels  are  freely  open,  or  have  been  re- 
laxed by  medicine,  but  where  the  tongue  still  continues  furred  ?  Such 
cases  Ave  often  meet  with  in  gastric,  biliary,  or  intestinal  disturbance, 
and  sometimes  in  the  early  convalescence  from  acute  illness  the  tongue 
does  not  clean  so  quickly  as  it  should — a  sure  sign  of  impaired  digestion. 
Here  again  a  mercurial  preparation  or  podophyllin  is  useful,  given  with 
tincture  of  nux  vomica  and  nitric  acid.  If  the  motions  are  too  light  then 
give  a  third  or  half  a  grain  of  grey  powder,  night  and  morning  or  three 
times  a  day;  if  the  motions  are  too  dark  then  give  a  small  dose,  say  a 
thirtieth  to  twentieth  of  a  grain  of  podophyllin  resin,  night  and  morning. 
Five  drops  each  of  tincture  of  nux  vomica  and  dilute  nitric  aid  thrice 
daily,  will  much  promote  the  action  of  the  mercury  and  the  podophyllin. 
Sometimes  the  fur  is  dirty  or  brown,  and  the  patient  complains  of  a  dis- 
agreeable bitter  taste,  especially  in  the  morning,  and  this  symptom  is  an 
additional  indication  for  the  foregoing  treatment.  Sometimes,  however, 
in  spite  of  this  treatment,  the  disagreeable  bitter  taste  persists  in  the 
morning,  or  even  during  the  greater  part  of  the  day.  Einsing  the  mouth 
with  a  weak  solution  of  permanganate  of  potash  will  generally  temporarily 
remove  the  annoyance. 

As  the  tongue  cleans  the  fur  recedes  from  the  tip  and  edges  and  grad- 
ually becomes  thinner,  especially  at  its  margin.  With  a  little  practice 
we  can  generally  detect  when  the  cleaning  process  is  going  on. 

After  an  acute  illness,  like  typhoid  fever,  the  tongue  sometimes  parts 
w^ith  its  fur  in  flakes,  leaving  clear  smooth  patches,  especially  at  its  back. 
This  tongue  denotes  a  slow  convalescence.  In  typhoid  fever  this  tongue 
may  a  second  time  become  dry,  with  a  return  of  the  abdominal  symp- 
toms. In  a  case  like  this  turpentine  is  indicated  in  10  to  '^*0-minim  doses 
every  two  or  three  hours. 

A  dry  tongue  occurs  most  frequently  in  fever.  The  dryness  first 
invades  the  tip  and  extends  up  the  centre,  spreading  meanwhile  lat- 
erally, till  the  whole  tongue  becomes  dry.  It  grows  moist  in  the  inverse 
order  of  its  invasion.  A  dry  tongue  generally  indicates  nervous  depres- 
sion, often  shown  by  delirium,  usually  of  a  low  muttering  kind.  This 
nervous  prostration  is  often  dependent  on  want  of  sleep.  Narcotics  there- 
fore, like  choral,  bromide  of  potassium,  or  opium,  by  inducing  sleep, 
soothe  and  strengthen  the  nervous  system,  and  indirectly  moisten  the 
tongue.  Opium  is  often  more  useful  than  bromide  of  potassium,  or 
choral,  for  opium  appears  to  have  a  greater  effect  on  the  tongue  than 
either  of  the  other  drugs,  probably  inducing  a  moist  condition  by  its  direct 
action  on  the  tongue  and  stomach  as  well  as  through  its  sleep-producing 
effect  on  the  nervous  system. 

Being  frequently  a  sign  of  nervous  depression,  the  dr}'  tongue  becomes 
also  an  indication  for  giving  alcoholic  stimulants.  If,  liowever,  the 
nervous  depression  is  due  to  wakefulness  it  is  better,  if  possible,  to  secure 
refreshing  sleep  by  a  soporific,  which,  by  soothing  and  strengthening  the 


THE    TONGUE.  3 

nervous  system,  renders  the  tongue  moist,  promotes  digestion  and  assim- 
ilation, and  incites  the  patient  to  take  more  food. 

The  two  chief  uses  of  alcohol  are  to  assist  digestion  and  to  sustain  the 
nervous  system.  Now  sleep  is  the  best  restorative;  hence  fever  patients 
who  sleep  well  do  not  as  a  rule  require  stimulants. 

If  sleep  cannot  be  secured,  or  if  in  spite  of  sleep  the  tongue  remains 
dry  and  the  delirium  persists,  then  alcohol  is  indicated,  though  the  ]Hilse 
is  a  better  guide.  Usually,  however,  a  patient  with  a  dry  tongue  has  a 
frequent,  quick  and  compressible  pulse  calling  for  alcoholic  stimulation. 

Whilst  the  tongue  often  affords  evidence  of  the  necessity  for  alcohol, 
sometimes  it  shows  when  it  does  harm,  for  if  the  tongue  grows  coated  or 
drier,  it  is  evident  that  the  stimulant  is  doing  mischief. 

The  tongue  in  an  aged  person  often  readily  becomes  dry  even  in  non- 
febrile  illnesses;  hence  a  dry  tongue  has  not  quite  the  same  serious  import 
as  a  dry  tongue  in  a  younger  person.  If  with  the  dry  tongue  there  is 
sleeplessness  we  must  be  careful  how  to  give  soporifics;  for  though  in 
many  cases  a  soporific  is  very  beneficial,  yet  in  old  people  sometimes  it 
produces  great  excitement.  If  the  dry  tongue  is  associated  with  depression 
or  exhaustion  we  not  at  all  rarely  find  that  alcohol  increases  the  dryness 
and  destroys  the  appetite;  hence,  at  first,  stimulants  must  be  given  to 
aged  patients  in  a  small  quantity,  the  effect  of  which  must  be  carefully 
Avatched. 

The  color  of  the  tongue  is  a  useful  sign.  A  broad,  pale,  flabby  teeth- 
indented  tongue,  indicates  anfemia  with  a  relaxed  condition  of  the  tissues. 

It  is  met  with  in  simple  antemia,  and  chlorosis,  and  in  some  chronic 
diseases,  as  in  Bright's  disease,  in  which,  in  addition  to  anaemia,  there  is 
hydremia — an  excess  of  water  in  the  blood.  This  tongue  always  signifies 
the  need  for  iron;  and  the  astringent  preparations  in  large  doses,  are,  as  a 
rule,  far  the  best.  A  swollen  teeth-indented  tongue  during  a  course  of 
mercury,  is  one  of  the  earliest  signs  of  salivation. 

In  diabetes,  in  severe  and  advanced  cases,  the  tongue  is  often  charac- 
teristic. It  becomes  smooth,  glazed,  shiny,  beefy-looking,  abnormally 
clean,  often  with  a  tendency  to  become  dry,  and  sometimes  quite  dry. 

The  tongue  may  be  red,  with  prominent  red  papilla?  most  marked  at 
the  tip;  and  this  red  tongue  too  clean,  too  smooth,  or,  slighty  furred 
points  to  ' '  the  irritable  tongue  "  and  a  coi-responding  state  of  the  stomach. 
It  is  met  with  in  certain  dyspeptic  cases,  sometimes  in  drunkards,  and 
especially  in  phthisis  when  the  intestines  are  ulcerated  or  there  is  tuljer- 
cular  peritonitis.  Small  doses  of  arsenic,  say  one  minim  of  the  liquor, 
given  shortly  before  food,  will  generally  improve  this  tongue  aiid  the  as- 
sociated conditions.  It  should  be  borne  in  mind  that  great  irritation  of 
the  stomach  or  intestines  or  tubercular  peritonitis  may  exist,  unaccom- 
panied with  this  irritaljle  tongue. 

In  scarlet  fever,  a  few  days  after  its  commencement  and  before  the 
fever  declines,  this  tongue  is  met  with,  and  it  continues  during  the  eiwly 
part  of  convalescence.  It  is  the  very  characteristic  "  strawberry  tongue," 
always  suggestive  of  scarlet  fever.  Its  appearance  arises  from  desquama- 
tion of  the  tongue,  for  the  cuticle  of  the  tongue  being  moist  is  more  easily 
separated  than  the  cuticle  of  the  skin,  hence  the  tongue  desquamates  some 
days  before  the  skin.  I  need  hardly  say,  that  whilst  the  fever  lasts,  we 
should  not  treat  the  tongue  with  arsenic,  though,  if  convalescence  is  te- 
dious and  the  tongue  retains  its  strawberry  cliaracter,  arsenic  and  nitric 
acid  will  be  found  useful. 


THE    PULSE. 


The  "  nervous  tongue  "  is  also  very  noteworthy:  generally  it  is  very 
slightly  coated  and  covered  with  a  slight  froth,  most  marked  close  to  the 
edge.  We  meet  with  it  in  persojis  of  nervous  temperament,  especially 
during  the  period  of  excitement,  and  in  cases  where  the  nervous  system 
has  been  depressed  by  overwork,  and  worry. 


THE  PULSE. 


With  each  contraction  of  the  heart,  a  wave  is  sent  through  the 
arterial  system,  which,  in  its  journey  along  the  vessels,  distends  them, 
and  this  periodical  distention,  readily  felt  when  the  fingers  are  placed  on 
an  artery,  is  the  pulse.  Dr.  Broadbent.  however,  denies  that  the  pulse 
is  due  to  distention  of  the  artery,  and  ascribes  it  to  the  wave  forcing  or 
trying  to  force  the  vessel  flattened  by  pressure  of  the  finger  back  to  its 
cylindrical  form.  The  pulse,  therefore,  depends  on  the  heart;  and  varies 
with  the  condition  of  the  heart.  It  is  influenced  also  by  the  condition 
of  the  vessels,  the  pulse  varying  according  to  the  contracted  or  dilated 
condition  of  the  arteries;  moreover,  it  is  also  modified  when  the  walls  of 
the  vessels  become  fibrous  or  calcareous.  The  pulse  is  an  accurate  index 
of  the  condition  of  the  heart,  and  is  therefore  the  most  valuable  guide  in 
disease. 

The  importance  of  the  pulse  is  manifest  when  we  consider  that  disease 
kills  by  arresting  the  heart.  Whilst  tlie  heart  beats  there  is  life  and  hope. 
In  many  instances,  the  pulse  gives  the  promptest  signs  of  danger  and  the 
earliest  indications  for  treatment.  To  illustrate  this  by  an  example,  take  the 
case  of  pneumonia,  in  which  disease  so  long  as  the  pulse  continues  good 
we  have  fair  hopes  of  our  patient.  In  some  patients  the  heart  fails  early 
and  the  pulse  soon  reveals  this  condition;  the  patient  fails,  Ave  say,  at  the 
heart.  In  other  instances,  the  nervous  system  first  gives  way,  shown  by 
sleeplessness  and  muttering  deli' :um:  but  though  these  symptoms  cause 
anxiety,  yet  so  long  as  the  pulse  remains  good,  we  hope  to  save  our  patient. 
The  anxiety  we  feel  with  regard  to  this  nervous  perturbation  arises  from 
its  depressing  effect  on  the  heart;  for  if  the  patient  does  not  sleep,  this 
unrest,  with  the  consequent  dehrium,  rapidly  depresses  and  weakens  the 
patient,  and  at  last  arrests  the  heart.  The  disease,  therefore,  may  directly 
tell  on  the  heart,  or  it  may  indirectly  affect  this  organ  by  its  depressing 
effect  on  another  system.  In  any  case  it  is  the  ultimate  effect  of  the  dis- 
ease on  the  heart  that  destroys  life.  It  is  hardly  possible,  therefore,  to  over- 
estimate the  cardinal  importance  of  the  ptilse.  The  pulse-beats  may  be 
frequent  or  infrequent;  slow  or  quick;  small  or  large;  compressible  or 
incompressible;  regular  or  irregular;  or  intermittent. 

By  the  frequency  of  the  pulse  we  mean  the  number  of  beats  in  a  given 
time. 

In  a  quick  pulse  each  beat  occupies  less  than  the  usual  time,  that  is, 
each  wave  is  of  short  duration  relatively  to  the  pause  between  the  waves. 

When  the  volume  of  the  pulse  is  greater  than  usttal.  it  is  said  to  be 
large;  or  the  volume  may  be  less  than  usual,  when  it  is  said  to  be  small. 


THE    PULSE.  5 

When  the  fingers  can  easily  stop  the  pulse  it  is  said  to  be  compress- 
ible; when,  on  the  other  hand,  it  can  be  arrested  only  with  difficulty  or 
not  at  all,  the  pulse  is  said  to  be  incompressible. 

The  pulse  may  be  irregular  or  intermittent.  In  an  irregular  pulse, 
succeeding  beats  differ  in  length,  force,  and  character.  In  an  intermit- 
tent pulse  a  beat  is  from  time  to  time  lost. 

The  frequency  of  the  healthy  pulse  varies;  thus  in  some  persons  the 
normal  pulse  is  100,  in  others  as  low  as  50  a  minute,  but  these  extremes 
are  rare. 

Five  conditions  produce  a  frequent  pulse:  Fever,  debility,  excitement, 
hysteria,  and  cardiac  disease,  as  in  some  cases  of  mitral  disease;  and  the 
pulse  in  exophthalmic  goitre  is  greatly  accelerated.  We  seldom  experi- 
ence difficulty  in  determining  the  cause  of  the  accelerated  pulse.  In  ex- 
citement the  acceleration  is  not  persistent  and  lasts  only  whilst  the  excit- 
ment  continues.  Hysteria  may  greatly  and  permanently  accelerate  the 
pulse  to  even  150  or  160  beats  per  minute.  But  in  a  grave  illness,  whether 
febrile  or  not,  liysteria,  if  present  before,  generally  passes  away  at  unce,  so 
that  we  may  safely  attribute  the  frequent  pulse  to  the  invasion  of  another 
and  more  serious  disease. 

In  fevers  the  pulse  is  generally  accelerated  in  proportion  to  the  eleva- 
tion of  temperature,  though  the  proportion  between  the  pulse  and  tem- 
perature varies  in  different  fevers.  In  scarlet  fever,  the  pulse  is  more 
frequent  than  in  typhoid  fever  with  the  same  temperature,  hence  a  fre- 
qvTent  pulse  is  of  less  serious  import  in  scarlet  than  in  typhoid  fever. 
The  same  elevation  of  temperature  accelerates  the  pulse  relatively  much 
more  in  children  than  in  adults. 

When  a  pulse  is  more  frequent  than  the  temperature  will  explain,  it  in- 
dicates cardiac  weakness — the  weakness  being  proportionate  to  the  want  of 
ratio  between  the  temperature  and  pulse.  In  this  way  the  pulse  affords 
important  information  in  prognosis  and  treatment. 

A  pulse  that  day  by  day  progressively  increases  in  frequency,  the  tem- 
perature remaining  the  same,  shows  increasing  cardiac  weakness. 

In  all  febrile  diseases,  a  pulse  in  adults  over  120  is  serious  and  indi- 
cates cardiac  weakness,  a  pulse  of  130  or  140  indicates  great  danger,  and 
with  a  pulse  at  160  the  patient  almost  always  dies.  There  is,  however, 
a  notable  exception  to  this  rule,  in  rheumatic  fever.  In  estimating  the 
value  of  the  pulse  in  this  disease,  we  must  carefully  ascertain  whether 
rheumatic  fever  itself  or  pericarditis  occasions  the  increased  frequency. 
A  pulse  of  120,  if  due  to  the  rheumatic  fever,  indicates  great  danger.  In 
such  a  case  the  temperatu.re  is  high,  104  to  105,  the  patient  is  prostrate, 
the  tongue  pro1)ably  dry,  and  sordes  collect  on  the  lips:  a  case  like  this 
often  ends  fatally,  and  when  the  pulse  rises  above  120,  say  to  130  or 
higher,  the  patient  will  pretty  surely  die. 

If  pericarditis  causes  the  frequent  pulse,  it  becomes  then  of  far  less 
serious  import,  though  the  pulse  may  rise  to  150  to  100  per  minute. 
Not  unfrequently  we  meet  with  such  cases  where,  with  but  slight  rheu- 
matic fever,  severe  pericarditis  with  perhaps  extensive  effusion  sets  in. 
The  temperature  is  not  greatly  raised,  rising  only  to  101°  or  102"  Fah., 
the  tongue  remains  clean  or  but  slightly  coated.  Now  in  a  case  of  this 
kind,  though  the  beats  rise  even  to  ICO  and  the  pulse  becomes  very  bad 
in  other  qualities,  being  very  compressible  or  even  small  and  compressible, 
yet  we  may  reasonably  expect  the  patient  to  recover.  The  heart's  sub- 
stance too  is  generally  inflamed;  and  this  weakening  of  the  heart's  sub- 


b  THE    PULSE. 

stance,  coupled  with  the  mechunical  embarrassment  arising  from  the  peri- 
cardial effusion,  excites  very  hurried,  even  panting  breathing.  Thus 
attacked,  the  patient  often  looks  very  ghastly,  the  face  l)ecomes  dusky 
and  distorted  with  the  hideous  risus  sardonicus;  yet  if  these  symptoms 
can  be  clearly  traced  to  the  cardiac  mischief,  we  may  hold  a  well-grounded 
hope  of  the  patient's  recovery,  even  without  the  aid  of  large  doses  of  alco- 
holic stimulants.  In  fact,  acute  pericarditis  is  rarely  immediately  fatal; 
it  remotely  destroys  life  only  by  leading  to  dilatation  with  valvular  incom- 
petency, or  to  fatty  degeneration  of  tne  heart. 

Rheumatic  fever  with  other  complications  generally  ends  favorably,  no 
matter  how  serious  the  aspect  of  the  patient.  Pneumonia,  even  Avhen 
double  and  further  complicated  with  extensive  pericarditis,  seldom  de- 
stroys a  patient. 

Again,  an  irregular  pulse  from  mitral  disease  may  be  very  frequent, 
120,  130  or  more,  without  indicating  extreme  danger.  Sometimes  in  acute 
fever,  as  typhoid  fever,  though  the  temperature  is  high,  the  pulse  remains 
normal  throughout  the  attack;  such  a  pulse  certainly  shows  absence  of 
cardiac  weakness,  and  is  of  course  a  favorable  sign. 

In  chronic  diseases  a  frequent  pulse  very  generally  indicates  cardiac 
weakness. 

With  increased  frequency  other  signs  of  cardiac  weakness  are  associated. 
The  weakened  heart  propelling  the  blood  less  energetically  than  in  health 
diminishes  arterial  tension  and  the  pulse  becomes  soft  and  compressible. 
Relaxation  of  the  arteries  plays  a  part  still  more  important  in  producing 
a  compressible  pulse;  this  condition  permits  the  blood  to  pass  with  greater 
readiness  into  the  veins,  and  so  to  lessen  arterial  tension.  This  relaxed 
condition  of  the  arterioles,  unless  the  heart  is  very  weak,  causes  the  pulse 
to  be  large  and  voluminous.  At  first  one  might  erroneously  suppose  that 
this  pulse  indicated  an  energetic  arterial  circulation  and  a  well-beating 
heart,  but  the  compressibility  soon  corrects  this  error.  It  is  therefore 
highly  important  always  to  test  the  compressibility  of  the  pulse.  If  the 
heart  becomes  still  more  weak,  and  the  arterioles  still  more  relaxed,  then 
each  beat  propels  little  blood  into  the  arteries,  and  these  allowing  the 
blood  to  pass  readily  into  the  veins,  the  pulse  becomes  small  as  well  as 
quick  and  compressible.  Smallness  of  the  pulse,  therefore,  indicates  still 
greater  weakness.  When  the  pulse  is  very  small  it  is  said  to  be  thready. 
When  the  heart  is  weakened  its  contraction  often  becomes  sudden  and 
sharp,  rapidly  reaching  a  maximum  and  rapidly  declining,  giving  rise  to 
a  quick  pulse,  which  thus  often  gives  evidence  of  cardiac  weakness,  es- 
pecially when  combined  with  the  other  and  surer  indications  of  this  state. 

Therefore,  in  estimating  the  condition  of  the  heart,  we  pay  regard  to 
the  frequency,  especially  with  reference  to  the  temperature,  to  the  com- 
pressibility, and  to  the  size  of  the  pulse.  The  more  frequent,  the  more 
compressible,  the  smaller  the  pulse,  the  greater  the  cardiac  weakness,  and 
the  more  imminent  the  patient's  danger,  and  the  greater  the  need  of  car- 
diac stimulants. 

These  pulse  signs,  therefore,  both  in  febrile  and  non-febrile  disease, 
are  indications  for  giving  cardiac  stimulants,  especially  alcohol.  These 
pidse  signs,  moreover,  afford  an  accurate  index  of  the  effects  of  alcohol 
and  of  the  amount  required;  for  alcohol  strengthens  the  debilitated  heart, 
reduces  the  frequency  of  its  beats,  and  contracts  the  vessels,  and  so 
heightens  arterial  tension  and  lessens  the  compressibility  of  the  pulse. 

ISoth  in  acute  and  chronic  affections  cardiac  weakness  is,  as  a  rule,  ac- 


THE   PULSE.  T 

companied  by  evidence  of  general  weakness,  though  this  by  no  means 
is  always  the  ease.  We  may  be  called  to  a  patient  with  an  acute 
illness  who  at  first  shows  no  evidence  of  Aveakness;  his  temperature 
is  found  to  be  from  102°  to  103°;  he  easily  turns  over  or  sits  up  in 
bed;  his  voice  is  strong;  his  tongue  moist  and  but  little  furred,  per- 
haps even  clean  ;  he  takes  his  food  and  apparently  digests  it  well. 
He  sleeps  well  at  night  and  is  free  from  delirium;  in  fact  the  general 
appearance  of  the  jjatient  indicates  no  danger;  but  the  pulse  beats 
say  130  per  minute,  and  it  is  small,  compressible,  and  quick;  and 
not  due  to  excitement,  as  we  ascertain  by  repeated  observations;  in 
fact  this  patient  is  in  considerable  danger.  Are  we  to  pay  regard  to  the 
pulse  or  to  the  general  condition  ?  Certainly  to  the  warning  pulse,  for  in 
a  case  like  this,  just  described,  serious  symptoms  will  set  in  in  a  few  days, 
and  the  patient  will  sink.  The  pulse  here  is  a  much  prompter  and  surer 
danger-signal  than  the  other  symptoms.  To  take  another  instance: — A 
febrile  patient  when  first  seen  presents  no  serious  symptoms,  but  as  the 
case  goes  on,  and  whilst  the  patient's  general  state  remains  apparently 
satisfactory,  the  pulse  gradually  increases  in  frequency  and  loses  in  force. 
Here  again  the  pulse  is  the  better  guide,  giving  early  indications  of  ap- 
proaching general  prostration. 

We  must,  however,  bear  in  mind  that  owing  to  individual  joeculiarity, 
the  pulse  in  some  persons  is  easily  made  very  frequent,  and  a  moderate 
amount  of  fever  may  accelerate  the  pulse  and  make  it  130  to  over  150, 
without  this  frequency  indicating  any  danger.  Our  previous  knowledge 
of  the  patient  will  alone  enable  us  to  rightly  estimate  the  frequency  of  the 
pulse  in  these  cases.  Again,  we  meet  with  cases  of  this  kind:  a  patient 
suffers  from  a  moderately  severe  attack  of  fever,  and  the  j)ulse  is  by  no 
means  frequent  in  proportion  to  the  fever,  but  it  is  very  small  and  very 
compressible.  In  forming  our  prognosis  are  we  to  be  guided  by  the  small- 
ness  and  compressibility,  or  the  frequency  of  the  pulse  ?  In  most  cases 
certaiidy  by  the  frequency.  The  size  and  compressibility  of  the  pulse 
varies  in  health  very  considerably  in  different  persons.  In  some  persons 
in  perfect  health  and  capable  of  vigoi'ous  exertion,  we  find  a  very  small 
and  compressible  pulse — that  might  even  be  called  thready.  Such  a  pulse 
often  occurs  in  various  members  of  the  same  family.  Now  if  such  a  person 
becomes  febrile  the  pulse  becomes  more  frequent,  and  without  any  cardiac 
weakness  is  of  course  small  and  compressible — and  it  is  obvious  if  we  dis- 
regarded frequency  and  paid  attention  only  to  the  size  and  compressibility, 
we  should  be  misled,  both  as  regards  prognosis  and  treatment.  Of  course 
our  previous  knowledge  concerning  the  patient  will,  in  many  instances, 
save  us  from  falling  into  error;  but  should  we  see  the  patient  for  the  first 
time  in  a  febrile  attack,  if  we  regarded  the  size  and  compressibility  rather 
than  the  frequency,  we  should  probably  be  misled.  Of  course  if  a  pre- 
viously good  pulse  becomes  small  and  compressible  this  change  is  significant, 
but  it  rarely  happens  that  this  change  occurs  without  a  corresponding 
increase  in  the  pulse's  frequency.         ^ 

It  is  true  that  sometimes  signs  oi  danger  arise  first  in  other  organs, 
perhaps  in  the  nervous  system,  in  the  form  of  sleeplessness  and  delirium, 
yet,  as  I  have  pointed  out,  so  long  as  the  pulse  remains  good  we  feel  that 
our  patient  is  comparatively  safe.  If  the  nervous  perturbation  neither 
spontaneously  declines  nor  yields  to  treatment,  the  pulse  will  ultimately 
fail  and  the  patient  will  sink. 

An  infrequent  pulse  occurs  in  some  cases  of  blood-poisoning,  as  in 
jaundice,  uraemia,  and  in  these  cases  the  temperature  is  often  subnormal. 


8  THE    PULSE. 

In  some  cases  of  pericarditis  at  its  commencement  the  pulse  jjreatly 
falls  in  frequency;  and  in  rheumatic  fever  if  the  pulse  changes  suddenly 
and  greatly  in  frequency,  especially  without  corresponding  cliange  of 
temperature,  we  should  expect  the  onset  of  pericarditis  or  other  cardiac 
complications. 

An  infrequent  pulse  is  met  with  sometimes  in  fatty  degeneration  of  the 
heart,  and  in  aortic  obstruction,  in  irritation  of  the  vagus  or  its  root,  as 
in  meningitis,  cerebral  tumors  or  compression.  In  defervescence,  the 
frequency  of  the  pulse  may  be  much  diminished. 

'I'he  size  of  the  pulse  varies  in  disease.  It  is  often  large  at  the  com- 
mencement of  fever,  the  ventricle  acting  strongly  whilst  the  arterioles  are 
relaxed.  It  is  rendered  larger  too  from  arterial  excitement.  In  aortic 
regurgitation,  the  pulse  is  very  large  during  systole,  but  during  diastole 
becomes  very  small  from  the  great  emptying  of  the  arteries. 

The  pulse  is  small  in  inanition  owing  to  the  small  quantity  of  blood. 
It  is  small  too  in  mitral  obstruction,  mitral  regurgitant  disease,  and  in 
aortic  stenosis,  also  with  cardiac  debility. 

In  an  intennitfent  pulse,  an  occasional  beat  is  missed,  the  rhythm  being 
otherwise  regular.  The  omitted  beat  may  occur  frequently  or  unfre- 
quently,  at  an  equal  or  irregular  interval.  It  must  be  clearly  understood 
that  an  bdenniUent  pnlse  is  very  different  from  an  irregular  jmlse,  and 
has  an  altogether  different  significance.  Some  persons  have  a  life-long 
intermittent  pulse,  but  ordinarily,  it  does  not  occur  till  after  middle  age.  It 
may  be  persistent  or  occasional;  and  when  occasional  only  it  is  often  due  to 
an  idiosyncrasy,  and  is  caused  by  some  article  of  food,  as  tea,  perhaps  green 
tea,  smoking,  or  indigestion.  Certain  patients  are  unconscious  of  the  inter- 
mission, and  as  Dr.  Broadbent  points  out,  this  is  especially  the  case  when 
the  intermission  is  habitual.  Other  persons  are  made  very  uncomfortable 
and  nervous  by  a  sensation  as  if  the  heart  stopped  or  rolled  over.  The 
intermission  often  occurs  in  the  artery  only  simultaneously  with  a  weak 
beat  of  the  heart. 

In  most  cases  an  intermittent  heart  is  of  no  significance,  and  does  not 
appear  in  any  way  to  imperil  life,  though  Dr.  Broadbent  states  that  a  patient 
so  affected  succumbs  more  readily  to  any  illness;  when,  however,  associated 
with  unequivocal  evidence  of  heart  disease  intermittency  is  of  more  serious 
import. 

An  irregular  is  of  far  more  serious  significance  than  an  intermittent 
pulse.  The  pulse  is  irregular  both  in  force  and  rhythm,  succeeding  beats 
differing  in  length,  force,  and  character.  It  is  generally  due  to  mitral 
and  rarely  occurs  in  other  forms  of  heart  disease,  though  sometimes  met 
with  in  great  cardiac  prostration,  as  in  an  acute  febrile  illness  a  few  hours 
before  death.  It  occurs  too  in  fatty  degeneration  of  the  heart  and  in 
the  first  and  second  stage  of  meningitis.  It  may  be  called  the  mitral 
pulse,  and  generally  indicates  the  need  of  digitalis,  which  in  most  instances 
lessens  or  removes  the  irregularity. 

Whilst  an  irregular  pulse  alm(^t  always  indicates  mitral  disease,  it 
must  be  borne  in  mind  that  a  perfectly  regular  pulse  may  accompany  ex- 
tensive mitral  disease;    either  obstructive  or  regurgitant,  or  both  combined. 

Some  hold  that  the  occurrence  of  irregularity  in  mitral  disease  is  a  sign  of  deficient 
compensation,  the  compensation  being  insufficient  to  meet  the  obstruction  to  tlie  cir- 
culation offered  by  the  initnil  disease.  But  were  this  view  correct,  how  does  it  hap- 
pen that  a  few  doses  of  digitalis  will  in  many  cases  restore  regidarity,  and  that  with 
the  discontinuance  of  the  digitalis  the  irrregularity  does  not  return  V 

The  irregular  pulse  is  very  rare  in  children  under  twelve,  though  the 


THE    PULSE.  y 

conditions  which  produce  it  in  adults  are  well  marked.  If,  say,  between 
six  and  seven,  mitral  disease  is  established,  and  the  child,  though  suffering 
from  its  effects  lives  till  it  is  over  twelve,  the  intermittency  then  becomes 
gradually  developed. 

Though  irregularity  from  mitral  disease  is  rare  in  children,  yet  I  have 
seen  aconite,  in  half-drop  doses  repeated  hourly,  several  times  produce 
marked  irregularity  of  the  pulse.  Irregularity  of  the  pulse  in  children  is 
common  in  the  first  and  second  stages  of  tubercular  meningitis;  in  fact 
its  existence  is  often  a  valuable  diagnostic  guide.  In  some  cases  of  cere- 
bral disease,  with  Cheyne-Stokes  breathing,  the  pulse  is  affected  by  the 
respirations;  as  these  grow  more  and  more  shallow  the  pulse  grows  slower 
and  slower,  and  then  becomes  frequent  when  the  patient  takes  a  deep  sigh- 
ing breath. 

An  irregular  pulse  may  be  due  to  much  smoking,  to  venereal  excess, 
and  to  tea-drinking. 

Hitherto  I  have  referred  to  the  dependence  of  the  pulse  exclusively  or 
mainly  on  the  condition  of  the  heart.  But  the  condition  of  the  blood- 
vessels themselves  also  influences  the  pulse. 

Through  the  action  of  the  vaso-motor  nerves  on  the  muscular  coat  of 
the  arteries,  the  small  blood-vessels  undergo  relaxation  or  contraction. 
When  the  vessels  are  relaxed  the  blood  passes  easily  from  the  arteries  to 
the  veins,  hence  arterial  tension  is  slight,  and  the  pulse  is  soft  and  com- 
pressible, but  owing  to  the  relaxed  state  of  the  vessels  it  is  also  large.  A 
relaxed  condition  of  the  arteries,  therefore,  produces  a  large,  soft,  com- 
pressible pulse. 

In  most  diseases,  a  relaxed  condition  of  the  arteries  is  associated  with 
a  weak  heart.  Sometimes,  however,  we  have  arterial  relaxation  with  a 
normal  heart,  in  which  case  the  pulse  is  soft  and  compressible,  but  large. 
This  pulse  is  met  with  in  the  early  stage  of  some  fevers. 

Arterial  relaxation,  or,  in  other  words,  diminished  arterial  tension,  pro- 
duces dicrotism.  In  this  pulse  one  of  the  normal  secondary  waves  of  oscil- 
lation becomes  greatly  exaggerated,  so  that  it  can  be  easily  felt  by  the  fin- 
ger. Indeed  it  may  be  so  distinct  that  an  inexperienced  person  mistaking 
it  for  the  primary  wave,  might  easily  be  led  erroneously  to  think  it  indi- 
cated a  cardiac  contraction.  Indeed  a  nurse  has  been  known  to  make  this 
mistake  and  thus  to  double  the  number  of  true  pulsations.  Dicrotism 
always  indicates  marked  arterial  relaxation,  and  often  coincides  with  car- 
diac weakness.  Some  writers  insist  that  this  pulse  indicates  the  use  of 
alcohol,  which  should  be  pushed  till  the  dicrotism  ceases.  JSTow,  in  this 
opinion  I  cannot  concur,  feeling  convinced  that  in  many  cases  with  marked 
dicrotism  no  alcohol  is  needed.  We  must  look  rather  to  the  frequency  of 
the  pulse,  and  if  this  shows  the  need  for  stimulation,  then  no  doubt  dicro- 
tism affords  additional  evidence  in  favor  of  giving  alcohol. 

A  dicrotous  pulse  is  frequently  met  with  in  typhoid  fever. 

I  now  come  to  the  pulse  of  liigh  arterial  tension;  here  the  vessels  are 
much  contracted,  and  then  as  the  blood  escapes  with  greater  difficulty  from 
the  arteries  into  the  veins,  the  arterial  tension  becomes  high.  In  some  of 
the  following  remarks,  I  largely  borrow  from  Dr.  Broadbent's  valuable  lec- 
tures on  the  pulse;  and  the  pulse  in  question  cannot  be  better  described 
than  in  his  own  words: — 

"The  artery,  usually  rather  small  but  sometimes  large,  is  hard  and 
cord-like;  it  can  be  rolled  under  the  finger  and  is  easily  traced  in  its  course 
up  the  forearm,  where  it  feels  like  another  tendon  lying  amidst  those  in 


10  THE   PULSE. 

front  of  the  wrist.  It  reminds  one,  as  I  have  often  said,  of  the  vas  defer- 
ens. " 

With  the  vessels  in  this  condition  the  pulsation  is  often  so  slight  that 
it  might  readily  be  mistaken  for  a  weak  pulse,  but  that  its  incompressi- 
bility  prevents  our  falling  into  this  error.  It  can  be  compressed  only  by 
using  considerable  foi'ce.  It  is,  in  fact,  a  sligbtly  pulsatile  pulse,  for 
owing  to  the  high  arterial  tension  the  vessel  with  each  beat  of  the  heart 
undergoes  but  little  dilatation,  hence  the  pulsation  is  indistinct.  In  addi- 
tion to  being  small  the  pulse  is  slow  and  hard. 

The  following  conditions  give  rise  to  arterial  tension — 

1.  Degeneration  of  vessels. 

2.  Bri gilt's  disease,  especially  the  contracted  kidney. 

3.  Gout,  jaundice;  lead-j)oisoning;  ergot;  gallic  acid. 

4.  Affections  of  the  nervous  system. 

5.  The  rigor  of  fevers. 

High  arterial  tension  accompanies  some  forms  of  Bright's  disease,  oc- 
curring in  the  fatty,  but  especially  in  the  acutely-inllamed  and  contracted 
kidney;  in  fact  high  arterial  tension,  and  hypertrophy  of  the  heart,  asso- 
ciated with  an  increased  quantity  of  urinary  water  containing  a  small  quan- 
tity of  albumen,  enable  us  to  diagnose  the  contracted  form  of  Bright's 
disease.  The  albuminoid  kidney  is  not  associated  with  high  arterial  ten- 
sion. 

Although  it  is  quite  true  that,  in  general,  a  soft  compressible  pulse  of 
low  tension  accompanies  a  weakly  acting  heart,  we  meet  with  exceptions 
to  this  rule.  For  a  patient  prostrate,  nay,  even  moribund,  and  conse- 
quently with  a  very  feebly  acting  heart,  may  have  a  high  tension  pulse, 
the  radial  artery  feeling  hard  and  remaining  to  the  touch  like  a  firm  cord, 
and  is  distinctly  traceable  some  way  up  the  forearm,  even  during  diastole; 
whilst  the  temporal  artery  is  also  firm  and  resistant.  This  combination  of 
a  high  tension,  and  therefore  small  and  resistant  pulse,  with  great  cardiac 
and  general  weakness  is,  I  think,  more  commonly  seen  in  children,  and  is 
sometimes  strongly  marked  in  tubercular  meningitis  and  capillary  bron- 
chitis or  broncho-pneumonia. 

It  is  obvious  from  these  facts  that  we  must  not  be  led  to  give  a  too 
favorable  opinion  because  of  the  high  tension  pulse.  "When  the  frequency 
and  the  tension  point  in  opposite  directions  we  must  rely  on  the  frequency 
rather  than  the  tension.  In  those  cases  where  the  heart  is  feeble,  though 
the  pulse  shows  high  tension  of  the  vessels,  we  can,  from  the  feel  of  the 
pulse  sometimes  detect  the  condition  of  the  heart,  and  thus  estimate  the 
true  state  of  the  patient,  without  having  regard  to  the  frequency  of  the 
pulse.  The  jiulse,  even  during  diastole,  feels  hard  and  resistant,  and  we 
can  trace  it  a  long  distance  beyond  the  point  where  it  is  usually  felt,  but 
each  systolic  distention  feels  smaller  than  usually,  even  with  high  tension 
of  the  vessels;  moreover,  with  slight  jiressure,  Ave  can  easily  arrest  the 
pulse-wave  along  the  vessel. 

Here,  perhaps,  I  may  profitably  introduce,  though  at  the  risk  of  some 
repetition,  an  account  of  the  modifications  the  pulse  undergoes  in  the 
stages  of  an  acute  illness.  First  I  will  refer  to  the  characters  of  the  pulse 
of  a  man  previously  -vngorous  and  robust  smitten  with  an  acute  disease. 
The  pulse  differs  in  the  separate  stages  of  the  fever,  in  the  chill,  the  acme, 
and  the  decline.  During  the  rigor  or  chill  the  arteries  contract,  and  pro- 
duce a  pulse  of  high  arterial  tension.  The  pulse  is  fi*equent.  small,  often 
verv  small,  hard,  incompressible,  and  long,  or  as  it  is  otherwise  ternietl. 


THE    PULSE.  11 

slow.  The  chill  over  and  the  fever  established,  the  arterioles  relax  and 
the  pulse  becomes  larger;  but  as  the  heart  is  not  yet  weakened  the  pulse 
is  large,  full,  and  not  easily  compressed, — bounding  as  it  is  called.  When 
the  fever  persists  during  many  days  and  the  patient  grows  weak,  the  pulse 
becomes  softer,  and  more  compressible,  short  (or  quick)  and  often  dicro- 
tous. 

In  the  case  of  a  fever  with  great  prostration  the  pulse  is  very  frequent, 
small,  short,  very  compressible,  these  characters  becoming  still  more 
marked  if  the  illness  terminates  fatrdly.  If  in  the  supposed  case  the 
patient,  previously  in  weak  health,  is  suddenly  attacked  with  an  acute  ill- 
ness, the  pulse  from  the  first  would  assume  this  character.  During  the 
decline  of  the  fever,  especially  when  it  ends  abruptly,  and  accompanied 
by  free  sweating,  the  pulse,  unless  the  patient  has  been  greatly  weakened, 
is  large, very  soft,  easily  compressed,  dicrotous,and  short — all  the  characters, 
indeed,  of  extreme  arterial  relaxation.  Indeed  in  febrile  diseases,  even  dur- 
ing their  height,  and  in  non-febrile  diseases  too,  when  tlie  skin  perspires 
freely,  this  is  generally  the  character  of  the  pulse.  And  this  also  is  the 
pulse  of  acute  rheumatism,  because  this  disease  is  usually  accompanied  by 
sweating.  Again,  in  a  febrile  disease,  when  by  means  of  a  drug  we  con- 
vert the  dry  into  a  moist  skin,  we  find  the  pulse  becomes  soft,  large,  but 
compressible. 

In  well-marked  aortic  regurgitation,  the  pulse  is  often  characteristic. 
It  is  a  pulse  of  extreme  low  tension.  In  this  afl^ection  the  blood  during 
diastole  flows  back  into  the  ventricle,  so  that  the  arteries  become  more 
or  less  emptied  of  blood.  The  ventricle  being  hypertrophied  and  dilated, 
propels  a  larger  quantity  of  blood  with  greater  force  than  usual  into  the 
partially  emptied  arteries,  and  suddenly  distends  them.  This  explains 
most  of  the  phenomena  of  the  aortic  regurgitant  pulse.  The  pulse  in 
great  arterial  relaxation  (low  tension)  may  simulate  the  pulse  of  aortic 
regurgitation,  for  great  arterial  relaxation  by  unduly  facilitating  the 
passage  of  blood  from  the  arteries  into  the  veins  empties  the  arteries  more 
than  usual,  and  these  unfilled  vessels  becoming  suddenly  distended  by  the 
normal  contraction  of  the  ventricle,  especially  during  excitement,  give  to 
the  finger  some  of  the  characters  of  an  aortic  regurgitant  pulse,  but  in 
a  much  less  marked  degree.  The  pulse  is  somewhat  sudden,  and  this 
quality,  as  is  the  case  with  aortic  regurgitation,  is  accentuated  by  raising 
the  arm  above  the  level  of  the  heart.  Further,  if  the  radial  is  at  all 
visible  with  the  limb  dependent,  this  visibility  becomes  much  more 
marked  on  raising  the  arm.  Indeed  it  may  become  visible  only  on  raising 
the  arm. 

The  pulse  of  aortic  regurgitation  is  of  two  kinds,  depending  on  the 
amount  of  regurgitation  and  the  strength  of  the  heart.  The  pulse  in 
early  cases  gradually  rises  as  usual  till  it  reaches  its  acme,  and  suddenly 
collapses,  the  collapse  being  due  to  the  regurgitation  of  the  blood  into 
the  ventricle. 

In  more  advanced  cases  the  pulse  gives  to  the  finger  a  sharp,  quick 
stroke.  The  extreme  suddenness  in  the  commencement  of  the  pulse,  as 
Dr.  Galabin  observes,  gives  to  the  finger  in  marked  cases  the  impression 
of  a  sudden  blow  or  jar.  This  is  the  diagnostic  quality  of  the  pulse.  In 
some  cases,  especially  when  the  heart  is  weak,  if  several  fingers  are  placed 
on  the  artery,  and  the  pressure  is  graduated,  the  pulse  feels  at  a  certain 
degree  of  pressure  as  if  a  small  ball  or  shot  was  puffed  under  each  finger. 
This  is  the  shotty  pulse. 


12  THE  pulsp:. 

This  cbiiractor  of  pulse  can  often  be  felt  best  by  gT'asping  the  wrist  with 
the  Avhole  hand,  so  as  to  feel  both  nlna  and  radial  arteries;  and  these 
characters  are  also  increased  by  raising  the  wrist  high  above  the  level  of 
the  heart,  thereby  enal)ling  gravitation  to  assist  the  aortic  regurgitation 
to  empty  the  arteries.  This  quality  of  pulse  is  often  oidy  felt  when  a  cer- 
tain degree  of  pressure  is  made  on  the  artery,  becoming  much  less  by 
diminishing  or  increasing  this  pressure. 

In  aortic  regurgitation,  as  Dr.  Corrigan  points  out,  the  pulse  is  often 
yisible  in  the  more  conspicuous  arteries.  In  fairly  nourished  persons  the 
radial  pulse  is  not  visible  in  health,  but  is  often  distinctly  visible  in 
healthy  thin  ]iersons.  In  aortic  regurgitation  it  becomes  far  more  visible 
at  the  wrist  when  the  arm  is  raised  over  the  head.  This  visible  pulsation  is 
probably  due,  as  Corrigan  points  out,  to  the  empty  condition  of  the  artery 
during  diastole.  The  blood  flows  easily  into  the  veins,  and  much  is  poured 
back  by  the  aorta  through  the  patent  aortic  orifice  into  the  ventricle, 
hence  the  imperfectly  filled  arteries,  on  receiving  the  impact  of  the  blood 
from  each  contraction,  become  widely  dilated. 

Is  visible  pulsation  diagnostic  of  aortic  regurgitation  ?  Certainly  not. 
Yisible  arterial  pulsatioi\  of  the  neck  and  head  accompanies  not  only  aortic 
regurgitation,  but  also  fibroid  degeneration  of  the  vessels,  great  arterial 
relaxation,  and  high  arterial  tension.  Mere  excitement,  by  increasing  the 
force  of  the  heart's  contraction,  often  in  nervous  persons  produces  visible 
carotid  pulsation,  and  this  phenomenon  is  more  frequent  in  women.  But 
this  nervous  pulsation  rarely  extends  more  than  half  way  up  the  neck, 
and  hence  can  generally  be  at  once  detected  from  the  visible  carotid  pul- 
sation due  to  more  serious  causes.  Visible  pulsation  of  the  whole  length 
of  the  carotid  to  the  lobe  of  the  ear  and  of  the  temporal,  and  perhaps  of 
the  facial  artery,  is  far  more  frequently  due  to  aortic  regurgitation  than 
to  high  arterial  tension  or  to  the  opposite  condition,  low  arterial  tension, 
or  to  degeneration  of  the  arteries.  Therefore  extensive  visible  arterial 
j)ulsation  in  the  neck,  that  is,  when  the  pulsation  can  be  distinctly  seen 
as  far  as  the  back  of  the  lobe  of  the  ear,  is  strongly  suggestive  of  aortic 
regurgitation;  though  I  should  mention  that  visible  pulsation  is  well 
marked  in  pericarditis  accompanied  by  carditis  or  pericardial  effusion,  con- 
ditions generally  associated  with  marked  arterial  relaxation. 

Aortic  regurgitation,  degeneration  of  the  arteries,  and  high  arterial 
tension,  will  produce  distinct  visible  pulsation  not  only  of  the  carotid,  but 
likewise  of  the  brachial,  radial,  ulna,  etc. 

These  three  conditions— aortic  regurgitation,  arterial  degeneration, 
and  high  arterial  tension — may  be  combined.  Aortic  regurgitation  is  es- 
pecially a  disease  of  middle  or  advanced  life;  the  endo-arteritis  and  endo- 
carditis producing  aortic  and  arterial  degeneration  being  due  to  age  and 
strain  from  some  laborious  occupation.  Ulie  chronic  inflammation  often 
afl'ects  the  entire  arterial  system  even  to  the  smallest  vessels,  and  by  ren- 
dering them  inelastic,  and  by  narrowing  the  lumen  of  the  smaller  vessels 
friction  is  increased — a  greater  hindrance  is  ofliered  to  the  passage  of  the 
blood,  and  the  tension  of  the  vessels  rises. 

How  can  we  distinguish  between  the  visible  brachial  pulsation  due  to 
some  simple  arterial  degeneration,  and  that  due  to  simple  aortic  regurgita- 
tion ?  In  arterial  degeneration  the  arteries  become  elongated  and  tortuous, 
easily  visible  in  the  brachial  Just  above  the  elbow.  A  tortuous  pulse, 
therefore,  always  suggests  arterial  degeneration.  Moreover,  in  arterial 
degeneration  the  arteries  feel  hard  and  cordy  even  when  all  blood  is 


THE    PULSE.  13 

pressed  out  of  them,  and  sometimes  calcareous  plates  or  atheromatous 
hardenings  can  be  distinctly  felt.  A  tortuous  condition  of  the  arteries, 
as  of  the  bracliial,  does  not,  however,  always  point  to  degeneration,  for 
as  Dr.  Broadbent  tells  me  in  confirmation  of  my  own  experience,  this 
tortuosity  may  be  produced  by  high  arterial  tension,  but  says  it  occurs 
only  when  high  arterial  tension  has  endured  for  some  time,  and  is  not 
seen  in  the  cases  of  high  arterial  tension  accompanying  acute  Bright's 
disease. 

Long  ago.  Dr.  Corrigan  pointed  out  that  raising  the  arm  increased 
the  visibility  of  the  radial  pulse  in  aortic  regurgitation,  and  he  used  this 
fact  to  support  his  theory  of  the  production  of  visible  arterial  pulsation 
in  aortic  regurgitation.  This  increased  visibility  of  the  radial  pulse  on 
raising  the  arm  will  not,  however,  enable  us  to  diagnose  aortic  regurgita- 
tion, for  in  arterial  degenei'ation  the  visible  radial  jDulse  becomes  decidedly 
more  obvious  in  this  position,  though  perliaps  not  so  great  in  a  degree 
as  in  well-marked  aortic  regurgitation.  I  may  mention,  that  in  children 
even  with  considerable  aortic  regurgitation  the  pulse  is  rarely  visible. 

In  many  cases  of  advanced  aortic  regurgitation,  when  the  observers 
ear  is  placed  in  the  palm  of  the  patient,  raised  above  the  level  of  the 
heart,  each  beat  of  the  pulse  is  distinctly  audible.  Extreme  arterial  re- 
laxation without  aortic  regurgitation  will  produce  this  thud-like  sound. 
It  is  probably  due  to  the  sudden  distension  of  the  relaxed  arterial  walls. 
In  advanced  cases  a  double  murmur,  too,  may  be  produced  by  pressing 
the  stethoscope  on  a  large  artery.  This  double  murmur  is  heard  best 
over  the  femoral,  just  at  Poupart's  ligament.  The  diastolic  murmur  is 
only  audible  with  a  certain  degree  of  pressure,  and  is  often  quickly  lost 
by  any  increase  or  diminution  of  it.  The  systolic  murmur  can,  of  course, 
be  produced  in  health  by  pressure.  It  is  the  diastolic  murmur  which 
points  to  aortic  regurgitation. 

In  aortic  regurgitation  we  often  meet  with  the  capillary  pulse,  first 
noticed  by  Quincke,  who  points  out  that  it  also  sometimes  occurs  in 
health,  and  is  best  seen  under  the  finger  nails.  It  is  not  visible,  I  believe, 
in  the  skin  of  the  forehead  in  healthy  jiersons,  but  a  slight  pulsation  some- 
times occurs  in  cases  of  very  low  arterial  tension.  I  have  seen  it  after  a 
copious  ha3morrhage.  It  is  much  more  marked  in  aortic  regurgitation, 
if  the  regurgitation  itself  is  marked.  "When  the  skin  is  reddened  by 
irritation,  the  blush  pulsates  synchronously  with  the  heart's  beat.  It  is 
observed  best  in  parts  situated  on  a  higher  level  than  the  heart,  as  the 
forehead  and  temporal  region.  With  each  diastole  the  skin  becomes  pale 
and  reddens  again  with  the  systole.  The  explanation  of  these  changes 
is  obvious.  During  diastole  the  blood  flows  back  into  the  ventricle,  and 
the  arteries  become  comparatively  empty,  those  especially  situated  above 
*the  cardiac  level;  hence  during  diastole  the  irritated  skin  grows  pale,  but 
the  systole  again  fills  the  dilated  vessels,  and  a  blush  diffuses  itself  over 
the  skin.  The  capillary  pulse  is  also  visible  in  the  extremities,  but  is 
much  more  marked  when  hand  or  foot  is  raised  above  the  heart's  level. 
This  capillary  pulse  is  well  exemplified  in  the  sole  after  reddening  the 
skin  by  putting  the  foot  in  hot  water  or  mustard  and  water.  It  is  well 
brought  out  by  wrinkling  the  skin,  by  strongly  extending  the  foot  and 
flexing  the  toes.  The  skin  along  the  wrinkles  becomes  pale,  but  reddens 
with  each  systole.  The  pulsation  is  well  marked  even  Avhen  the  foot  rests 
below  the  heart's  level,  for  the  wrinkles  in  the  skin  press  on  the  capilla- 
ries and  empty  them;  but  the  systole  is  strong  enough  to  refill  them  and 


14  THE  ruLSE. 

to  redden  the  previously  pale  skin.  As  would  be  expected,  pressure  on 
the  artery  supplying  the  surface  under  observation  arrests  the  visible 
capillary  pulsation. 

Brunton  describes  a  capillary  pulsation  synchronous  with  respiration 
as  Avell  as  the  heart's  beats.  He  also  suggests  that  there  may  be  a  third 
cause  of  the  increased  redness,  namely,  the  peristaltic  contraction  of  the 
arteries,  and  certainly  one  sees  blanching  and  redness  which  are  not  de- 
j)endent  on  the  heart  or  breathing  occurring  less  frequently  than  the  res- 
pirations and  lasting  longer  than  a  respiration. 

The  pulse  of  aortic  obstruction,  so  long  as  the  left  ventricle  remains 
imdegenerated,  is  slow,  generally  small,  infrequent,  and  often  hard.  It 
is  slow"  and  small,  because  even  the  hypertrophied  ventricle  can  force  the 
blood  but  slowly  through  the  narrowed  aortic  orifice.  It  is  infrequent 
because  of  the  great  length  of  each  systole.  If  there  is  co-existing  in- 
sufficiency, of  coiirse  the  character  of  the  pulse  is  much  modified.  When 
compensation  fails,  the  pulse  becomes  small  and  compressible. 

In  marked  mitral  obstructive  disease,  the  pulse,  when  not  irregular, 
is  small  and  compressible. 

In  arterial  degeneration  the  vessels  become  elongated,  tortuous,  and 
the  pulse-beats  become  very  visible.  The  artery  feels  hard  and  like  a 
cord,  or  like  the  vas  deferens,  and  sometimes  the  calcareous  plates  may 
be  felt  even  in  the  radial  ratery  at  the  wrist.  This  is  a  very  significant 
condition,  being  evidence  of  senile  decay  of  the  arteries,  a  condition  which 
leads  to  atrophy  and  degeneration  of  the  organs.  Many  j^ersons  are  con- 
stitutionally much  older  than  their  years  will  warrant — they  are,  in  fact, 
jH'ematurely  old;  while,  on  the  other  hand,  many  old  people  show  few 
signs  of  old  age.  In  individuals  prematurely  old  the  arteries  are  found 
in  a  state  of  degeneration,  while  in  hale  old  peoi^le  their  arteries  show 
few  or  no  signs  of  degeneration;  it  has  been  well  said  that  a  man  is  as 
old  as  his  arteries. 

The  pulse  in  this  condition  is  weak,  and  if  the  artery  is  rigid  there 
may  be  no  pulse.  In  a  sphygmogram  the  line  of  ascent  is  slow,  and  less 
than  normal.  The  top  of  the  trace  is  rounded,  and  the  line  of  descent 
is  more  gradual  with  less  distinct  secondary  waves. 

The  pulse  may  be  delayed  at  a  distance  from  the  heart.  This  occurs 
in  arterio-sclerosis  (fibroid).  If  this  condition  is  more  marked  on  one 
side,  or  if  the  origin  of  the  vessel  as  it  arises  from  its  trunk  is  narrowed, 
then  the  pulse  beats  later  on  this  than  on  the  opposite  side.  Aneurism 
of  the  aorta,  too,  often  delays  the  pulse,  and  it  may  do  this  on  one  side 
more  than  the  other,  or  on  one  side  alone.  In  aneurism  of  the  aorta  in- 
fluencing the  arteries  of  one  arm  only,  the  artery  on  this  side  can  be  felt 
to  fill  more  slowly,  and  sometimes  the  distension  of  the  artery  is  dis- 
tinctly divided  into  two  parts,  by  two  impulses  almost  continuous,  the 
second  being  the  less  considerable.  These  effects  are  still  better  seen  in  a 
sphygmogram,  where  the  line  of  ascent  is  delayed  (and  it  may  consist  of 
two  parts),  the  top  of  the  trace  is  rounded  and  the  waves  in  the  line  of 
descent  are  much  less  distinct. 

Dr.  Augustus  AValler  describes  a  "  recurrent  pulsation  in  the  radial 
artery."  After  compressing  the  radial  pulse  and  completely  obliterating 
it,  he  points  out  that  in  many  cases  the  pulse  still  beats  at  the  distal  side 
of  the  fingers.  The  arterial  wave  Avhich  produces  the  pulsation,  he  ex- 
jilains,  comes  from  the  ulna  artery  and  travels  through  the  radio-ulna 
inosculating  arteries,  and  so  reaches  the  radial  artery.     If  the  ulna  artery 


i 


THE    SKIN".  15 

likewise  is  compressed  this  pulsation  at  .the  distal  side  of  the  fingers 
ceases.  -This  "  recurrent  pulsation  "  is  found  generally  in  persons  with 
relaxed  arteries,  in  wiioni  the  heart  beats  fairly  well;  for  a  weak  heart  is 
unable  to  propel  a  wave  from  the  ulnar  to  the  radial  artery.  Dr.  Wal- 
ler finds  this  recurrent  pulse*  twice  as  often  in  women  as  in  men. 


THE    SKIN. 


The  condition  of  the  skin  affords  us  a  series  of  instructive  symp- 
toms; but  in  this  j)lace  I  must  restrict  myself  to  speak  only  of  a  dr}',  a 
moist,  and  a  profusely  wet  and  sodden  skin. 

In  most  fevers  with  persistently  high  temperature  the  skin  is  hot, 
often  pungently  hot.  Now,  if  we  make  the  jDatient's  skin  comfortably 
moist,  we  shall  considerably  promote  his  comfort  and  well-being.  Small 
often-repeated  doses  of  tincture  of  aconite,  or  tartar  emetic,  or  full  doses 
re})eated  every  three  hours  of  spirit  of  mindererus,  will  induce  perspi- 
ration. Aconite  and  tart:ir  emetic  are  the  most  efficient;  in  fevers  with- 
out lung  implication  aconite  is  best,  but  in  catarrh,  bronchitis,  or  pneu- 
monia, tartar  emetic  is  preferable. 

In  many  cases  of  diabetes  and  Bright's  disease,  it  is  very  difficult  to 
make  the  very  dry  skin  perspire. 

The  occurrence  of  sweating  often  suggests  hints  for  treatment  or 
assists  the  prognosis. 

The  two  chief  causes  of  sweating  are  weakness  and  a  fall  in  a  febrile 
temperature,  two  causes  often  combined  in  the  same  person  in  exhaust- 
ing febrile  disease,  as  in  phthisis. 

In  a  non-febrile  patient,  the  readiness  to  perspire  often  indicates 
weakness,  and  even  measures  its  amount;  thus,  in  depressed  health,  a 
person  finds  that  exertion,  even  slight  exertion,  or  any  excitement,  causes 
too  free  sweating.  A  trainer  knows  well  that  a  trainee  is  in  bad  condition 
when  he  perspires  too  freely. 

Again,  in  exhausting  diseases,  and  during  the  weakness  of  convales- 
cence, slight  exertion,  or  even  sleep,  produces  sweating,  often  profuse.  It 
must,  however,  be  borne  in  mind,  that  in  sound  health  great  differences 
in  respect  to  the  amount  of  sweating  are  met  with  in  different  individuals. 
A  person  returning  from  a  residence  in  a  hot  climate  where  his  skin  has 
habitually  acted  very  freely,  finds  on  his  return  to  a  colder  climate  that, 
under  slight  exertion,  he  still  continues  to  perspire  very  readily. 

Profuse  sweating  occurs  during  the  sudden  fall  of  a  febrile  tempera- 
ture, as  in  the  sweating  stage  of  ague,  or  during  the  fall  of  temperature 
after  a  rigor  in  pygemia.  Phthisical  jiatients,  too,  in  whom  there  occurs 
a  great  diurnal  variation  of  temperature,  rising  to  102°  or  higher  at  night 
and  falling  in  the  early  morning  hours,  commonly  undergo  with  this  fall  a 
drenching  perspiration.  The  amount  of  sweating  in  febrile  cases  depends 
on  the  extent  of  the  fall  of  temperature  and  the  weakness  of  the  patient; 
where  the  weakness  is  great,  the  sweating  is  often  profuse,  though  the  fall 
in  the  temperature  may  measure  only  two  degrees  or  less. 

These  two  forms  of  perspiration  when  uncombined  can  be  easily  dis- 
criminated. Except  in  the  case  of  pyaemia,  there  occurs  in  febrile  dis- 
eases only  once  daily,  a  rise  and  a  fall  pf  temperature,  and  consequently 


16  THE    SKIN. 

sweating  when  due  to  a  fall  in  a  febrile  temperatnrc  occurs  only  once 
daily,  and  chiefly  early  in  the  morning.  In  weakness,  on  the  other  hand, 
sweating  breaks  out  at  any  hour,  and  many  times  a  day,  Ijeing  occasioned 
by  exertion,  sleei),  or  excitement. 

In  my  experience,  profuse  sweating  as  a  rule  is  more  common  and 
lasts  longer  in  the  convalescence  from  scarlet  fever  than  in  other  acute 
febrile  disease;  hence  during  the  recovery  from  scarlet  fever,  sudamin  a  in 
large  crops  often  occur,  greatly  hastening  desquamation,  the  skin  some- 
times coming  off  in  large  patches. 

AVith  the  exception  of  rheumatic  fever,  profuse  sweating  at  the  com- 
mencement of  an  acute  febrile  disease,  when  the  temperature  remains 
permanently  high,  indicates  great  weakness  and  adds  to  the  gravity  of  the 
prognosis;  when  besides  profuse  sweating,  there  is  duskiness  of  the  face, 
ears,  and  under  the  nails,  showing  weak  circulation  from  enfeeblement 
of  the  heart,  the  serious  aspect  of  the  case  is  strengthened.  Again,  the 
feel  of  the  skin  shows  the  condition  of  a  patient.  With  much  perspira- 
tion, the  skin  soft  and  sodden,  points  to  general  weakness,  a  state  accom- 
panied with  a  soft,  perhaps  large  compressible  pulse.  These  signs  often 
indicate  the  need  of  alcoholic  stimulants. 


TEMPERATURE    OF    HEALTH. 


17 


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18  TEMPERATURE    IN    DISEASE. 


THE   TEMPERATURE   OF   HEALTH. 

Within"  certain  narrow  limits  tlio  body  maintains  its  temperature  in 
health,  hut  within  these  limits  the  temperature  varies  in  a  definite  daily 
cycle.  During  the  day  the  temperature  remains  about  *.yS%  but  towards 
evening  it  begins  to  fall,  and  generally  reaches  its  minimum  at  midnight. 
At  this  point  it  remains  steady  during  a  few  hours,  and  then  begins  to 
rise,  reaching  its  maxmium  about  9  a.m.  The  diagram  of  the  tempera- 
ture of  a  lad  twelve  years  of  age  illustrates  the  daily  course  of  the  tempera- 
ture in  health. 

The  chart  shows  at  once,  that  a  temperature  normal  during  the  day 
would  be  abnormal  at  night,  and  vice  ver.su. 

During  the  day,  between  9  a.m.  and  4  p.m.,  the  healthy  temperature 
is  usually  about  99°;  thus  it  may  not  be  higher  than  98°,  or  it  may  rise 
to  99*5°  Fall.  Any  rise  above  99*5°  constitutes  fever.  About  four  in 
the  afternoon  the  evening  fall  begins,  and  at  midnight  the  temperature 
is  about  97°or  even  96°  Fah. 

Whilst  in  many  robust  adults  the  temiieratnro  runs  the  same  course  as  in  children, 
yet  with  others  the  course  is  scmiewhat  modified  from  that  just  described;  thus  the 
daily  cycles  are  not  so  considerable,  the  maximum  temperature  and  the  evening  fall 
being  less. 

In  persons  under  25  the  daily  variation  is  2°  Fah. ;  whilst  the  varia- 
tion in  persons  over  40  is  more  restricted,  being  often  only  1°  or  even  less. 

Jaeger  finds  that  the  daily  variation  is  greater  in  persons  whilst  labor- 
ing than  when  at  rest  At  rest  he  finds  the  average  daily  variation  to  be 
2.2,  whilst  during  hard  physical  work  the  daily  variation  amounts  to  4.7. 
His  experiments  were  made  on  soldiers,  the  observation  being  taken  in 
the  rectum. 


TEMPERATURE   IN  DISEASE. 

"Whilst  any  elevation  of  temperature  above  99.5°  indicates  disease,  it 
need  hardly  be  pointed  out  that  a  normal  temperature  does  not  necessarily 
indicate  health.  Many  diseases,  both  acute  and  chronic,  during  their 
whole  courses  are  unattended  with  fever.  Indeed,  in  some  diseases,  the 
temperature  is  depressed  below  the  health  standard. 

The  daily  course  of  fever  varies  Avitli  the  severity  of  the  disease.  In  a 
mild  attack  there  is  a  considerable  diurnal  variation,  the  temperature 
rising  toward  night  and  falling  in  the  early  morning  hours;  but  in  a  severe 
attack  of  febrile  illness  the  diurnal  variation  may  be  very  slight  or  even 
absent,  the  temperature  remaining  persistently  high. 

In  private  practice,  as  a  rule,  it  is  convenient  to  make  but  two  daily 
observations,  and  these  should  be  taken  at  such  times  as  to  obtain  the 
highest  and  lowest  temperature  of  the  day.  The  likeliest  times  to  give 
these  minimum  and  maximum  temperatures  are  8  to  9  A.  M.  and  8  to  9  p. 
M.  Though  as  a  rule  the  morning  temperature  is  lower  than  the  evening, 
in  rare  cases  the  reverse  happens.  In  some,  especially  in  chronic  cases,  as 
in  phthisis  and  sometimes  in  subacute  rheumatism,  the  fever  may  last  only 
for  a  few  hours  betAveen  8  a.m.  and  8  p.m.,  and  thus  observations  taken  at 
these  times,  though  the  temperature  is  then  normal,  do  not  absolutely 


TEMPERATURE    OF    FEVER.  19 

prove  that  the  patient  is  fever-free.  If  only  one  observation  daily  is  made 
it  should  be  taken  in  the  evening,  as,  even  in  the  diseases  so  severe  as 
scarlet  fever,  the  morning  temperature  may  be  nearly  normal  through- 
out the  attack,  while  the  evening  temperature  may  rise  to  103°;  hence  a 
morning  observation  only  would  lead  to  a  great  mistake  concerning  the 
severity,  and  possibly  the  nature,  of  the  illness. 


ABNORMAL  ELEVATION  OF  TEMPERATURE,  OR  FEVER. 

Many  diseases,  contagious  and  inflammatory,  are  accompanied  by  a 
rise  of  temperature.  It  must  be  borne  in  mind  that  the  same  amount 
of  disease  produces  in  children  a  relatively  higher  temperature  than  in 
adults,  and  that  there  are,  moreover,  probably  individual  or  family  pecu- 
liarities apt  to  raise  the  temperature  in  disease  beyond  the  ordinary 
standard. 

Some  chronic  diseases  modify  the  fever,  for  in  Bright's  disease  and 
diabetes  an  inflammation  may  produce  little  or  no  rise  of  temperature. 

The  derangement  of  function  in  a  febrile  disease  is  largely  often 
mainly  due  to  the  rise  of  temperature,  which  depresses  the  functions  of 
the  body,  and  if  of  much  intensity  or  duration  induces  parenchymatous 
degeneration  of  the  tissues,  which  likewise  depresses  function.  The  dan- 
gers, therefore,  in  a  febrile  disease  are  mainly  dependent  on  the  high 
temperature,  and  are  in  proportion  to  the  amount  of  elevation;  so  that 
we  take  the  degree  of  fever  as  a  measure  of  the  depressive  effect  of  the 
disease.  The  danger  from  a  high  temperature  may,  of  course,  be  aug- 
mented by  other  circumstances  as  the  diarrhoea  of  typhoid  fever. 

It  may  be  said,  perhaps,  that  the  symptoms — the  general  weakness, 
the  frequent,  feeble  pulse,  the  loss  of  appetite,  and  the  delirium,  are  due 
to  the  elevation  of  the  temperature;  and  this  remark  no  doubt  is  true, 
for  by  treatment  which  tends  to  reduce  the  temperature  to  the  normal 
standard  we  can  abate  or  remove  all  these  symptoms;  and  the  abnormal 
elevation  of  temperature  not  only  immediately  depresses  and  weakens  all 
the  bodily  functions,  but  in  proportion  to  the  height  and  duration  of  the 
fever  it  likewise  produces  degeneration  of  all  the  organs,  and  this  degen- 
eration greatly  weakens  the  activity  of  the  organs.  If  the  symptoms  are 
till  referable  to  the  direct  depressing  effect  of  the  fever  temperature,  and 
indirectly  through  the  degeneration  it  produces,  it  would  seem  a  plausible 
supposition  that  the  height  of  the  temperature  should  be  an  exact  measure 
of  the  patient's  danger.  A  little  reflection  will  soon  show  that  this  is  but 
partially  true,  for  though,  no  doubt,  most  of  the  symptoms  arise  from  the 
high  temperature,  it  must  be  recollected  that  its  depressing  effect  must 
greatly  depend  on  the  previous  condition  of  an  invaded  organ;  thus,  if 
previous  illness,  excesses  of  any  kind,  or  unhygienic  conditions  have  al- 
ready depressed  the  organs,  high  temperature  will  inflict  on  them  much 
graver  mischief.  If,  for  example,  rheumatic  fever  has  slightly  damaged 
the  heart,  a  febrile  attack  will  considerably  increase  the  dangers  to  the 
patient  through  failure  by  the  heart.  If  intemperance  has  injured  the 
nervous  system  a  febrile  disease  will  intensify  the  danger  of  delirium  and 


20  TEMPERATURE    OF    FEVER. 

depression  of  tlio  nervous  system.  AVe  estimate  tlie  resistive  power  of 
ouch  organ  by  the  severity  of  its  symptoms  in  comparison  with  tlie  lieight 
of  the  fever.  Thus,  if  delirium  is  excessive,  while  the  temperature  is  but 
slightly  elevated,  it  shows  that  the  nervous  system  has  but  little  power  to 
resist;  and  if  the  pulse  becomes  very  frequent,  small  and  compressible,  it 
shows  that  the  heart's  resistance  is  but  slight.  If,  on  the  other  hand, 
with  the  fever  severe  nervous  symptoms  are  slight,  and  the  pulse,  not  very 
frequfent,  is  full,  and  not  very  comjiressible,  then  we  conclude  that  the 
condition  of  the  nervous  centres  and  the  heart  is  satisfactory  and  our 
prognosis  is  good. 

Therefore,  in  estimating  the  dangers  of  a  febrile  attack,  we  must  re- 
gard not  only  the  severity  of  the  disease,  as  measured  by  the  temperature 
and  other  depressing  causes,  but  the  resisting  forces  of  the  body.  'J  he 
temperature  largely  measures  the  severity,  but  the  power  to  resist  fever  is 
estimated  only  by  careful  attention  to  the  condition  of  the  different 
organs,  especially  the  heart,  the  brain,  and  the  stomach. 

To  illustrate  these  remarks  take  two  ordinary  cases  of  typhoid  fever. 
One  patient  with  high  temperature  takes  and  digests  his  food  fairly 
well ;  he  sleeps  well,  his  heart  is  not  much  weakened,  and  yet,  in  spite  of 
the  high  fever,  or,  in  otlier  words,  the  severity  of  the  attack,  he  makes  a 
good  recovery.  Another  patient,  with  decidedly  less  fever,  is  troubled 
with  sickness,  sleeplessness,  delirium,  and  weak  heart,  and  so,  though 
his  attack  as  indicated  by  the  temperature  is  not  severe,  yet  he  dies  worn 
out.  Again,  take  two  cases  of  phthisis.  One  patient,  in  spite  of  consid- 
erable daily  fever,  eats,  digests,  and  assimilates  fairly  well,  and  for  the 
most  part  maintains  his  ground.  Another  patient,  though  his  fever  may 
be  slight,  and  indeed  sometimes  even  after  it  has  become  normal  or  below 
normal,  the  appetite,  digestion,  or  assimilation  being  greatly  impaired, 
slowly  but  surely  wastes  away.  In  certain  rare  cases,  though  the  appetite 
is  good  and  the  digestion  is  apparently  well  performed,  yet  if  assimilation 
is  at  fault  the  patient,  in  spite  of  plenty  of  food,  wastes  away,  even  in 
cases  when  the  temperature  has  become  normal.  Hence  in  a  case  of 
phthisis,  in  addition  to  the  fever  and  the  appetite,  we  must  note  the 
weight,  for  in  a  case  where  plenty  of  food  is  ingested  but  assimilation  is 
defective,  the  patient's  weight  is  the  sole  measure  of  his  progress. 

Does  the  course  the  temj)erature  runs  give  evidence  of  the  nature  of 
the  disease  ?  While,  on  the  whole,  this  question  must  be  answered  in 
the  negative,  still  it  must  be  remembered  that  certain  diseases  generally 
have  a  somewhat  characteristic  temperature;  indeed,  in  many  cases  of 
ague  and  pyaemia  the  temperature  itself  is  diagnostic. 

The  thermometer  assists  us  in  diagnosis  in  cases  of  the  following  kind : 
— A  patient  becomes  ill,  and  the  temperature  is  found  raised  above  the 
healthy  standard.  This  fact,  especially  if  the  temperature  is  high,  makes 
it  incumbent  on  the  doctor  to  search  carefully  to  discover  its  cause.  To 
narrow  the  range  of  our  instances,  let  us  restrict  our  attention  to  the  com- 
moner causes  of  fever.  The  fever  may  be  due  only  to  the  acute  contagious 
diseases,  acute  inflammation  of  some  organ,  rheumatism,  gout,  or  to  the 
diseases  causing  chronic  fever.  The  doctor,  we  will  suppose,  has  been 
called  in  on  the  first  day  of  the  attack,  and  his  duty  is  carefully  to  inves- 
tigate whether  the  fever  is  due  to  inflammation  of  any  organ.  In  most 
instances  the  symptoms  and  physical  signs  will  enable  him  to  arrive  at  a 
diagnosis,  an  attack  of  rheumatism  or  gout  being  so  characteristic  that  he 
will  detect  either  at  once.     If  the  fever  cannot  be  thus  accounted  for. 


I 


TEMPERATUKE    OF    FEVER.  21 

then  lie  probalDly  has  to  deal  with  one  of  the  acute  specific  diseases;  its 
nature,  however,  cannot  ordinarily  he  diagnosed  with  certainty  till  the 
characteristic  rash  appears.  Still,  even  before  the  advent  of  the  rash  he 
may  give  a  shrewd  guess  as  to  the  nature  of  the  illness.  Thus,  the 
patient  may  have  been  in  the  company  of  an  infected  person,  or  an  acute 
contagious  disease  may  prevail.  Moreover,  even  before  the  appearance  of 
the  characteristic  rash,  the  symptoms  may  suggest  one  of  the  acute  specific 
diseases.  Thus,  sore-throat  would  point  to  scarlet  fever;  severe  backache, 
headache  and  sore- throat  to  small-pox;  coryza  with  cough  to  measles.  Severe 
fever,  ushered  in  by  a  severe  rigoi*,  with  severe  headache,  and  pain  in  the 
limbs,  would  suggest  typhus;  whilst  dull  frontal  headache  with  diarrhoea, 
would  strongly  point  to  typhoid  fever.  The  mode  of  onset  of  the  fever, 
that  is  the  more  or  less  rapidity  with  which  the  temperature  mounts,  and 
the  more  or  less  elevation  which  it  reaches,  also  assists  the  diagnosis;  but 
this  point  will  be  more  dwelt  an  presently.  Having  then  in  many  cases 
a  strong  suspicion  as  to  the  nature  of  the  attack,  he  must  Avait  for  the  rash 
to  confirm  or  to  correct  his  impression.  If  the  second  day  passes  with 
out  the  occurrence  of  a  rash,  the  case  in  all  probability  is  not  one  of  scarlet 
fever;  for  the  rash  of  this  disease  appears  on  the  second  day,  being  very 
rarely  delayed  longer,  more  frequently,  indeed,  occurring  before  the  sec- 
ond day,  sometimes  even  in  twelve  hours.  If  the  third  day  lapses  with- 
out a  rash,  he  is  not  dealing  with  a  case  of  small-pox,  for  this  rash  usually 
appears  punctually  on  the  third  day.  In  measles,  it  is  commonly  said  that 
the  rash  appears  on  the  fourth  day,  but  in  many  cases  this  statement  is 
certainly  erroneous,  for  the  rash  often  appears  on  the  first  day  of  the 
fever,  and  I  have  seen  it  even  precede  the  fever.  In  many  instances, 
however,  though  there  is  no  fever,  the  patient  suffers  from  coryza  and 
cough  for  three  or  four  days;  but  these  symptoms  may  not  occur  till  the 
rash  appears  on  the  very  day  the  temperature  rises.  This  being  so,  it 
may,  however,  be  fairly  taken  that  if  the  fourth  day  passes  without  a  rash, 
the  case  is  not  one  of  measles.  If  the  fifth  day  passes  without  a  rash,  the 
case  is  not  typhus,  for  typhus  rash  appears  punctually  on  this  day.  The 
foregoing  diseases  being  excluded,  there  is  then  left  only  typhoid  fever, 
and  one  of  the  diseases  producing  chronic  fever;  and  the  diagnostic  diffi- 
culty will  lie  between  typhoid  fever  and  acute  tuberculosis,  the  other  dis- 
eases causing  chronic  feve^  being,  in  many  cases,  easily  detected. 

As  the  eruption  of  typhoid  throughout  the  attack  may  be  either  alto- 
gether absent  or  be  manifested  by  only  a  very  few  spots,  which  may  possi- 
bly escape  detection,  we  must  in  some  cases  diagnose  this  disease  irre- 
spective of  the  rash.  The  rash,  however,  appears  between  the  eighth  and 
twelfth  day,  which  makes  the  diagnosis  certain.  If  we  are  led  to  exclude 
typhoid,  then,  as  I  have  just  said,  we  have  probably  to  deal  with  a  disease 
which  causes  chronic  fever.  The  diagnosis  of  the  disease  referable  to  this 
head  will  be  treated  of  when  we  speak  of  chronic  fevers. 

I  now  give  another  instance  of  the  diagnostic  value  of  temperature. 
A  patient  is  suddenly  seized  with  severe  pain  on  tlie  side  of  the  chest. 
The  pain,  shooting  or  stabbing  in  character,  is  intensified  on  coughing  or 
deep  breathing.  This  is  the  characteristic  pain  of  pleurisy  and  of  pleuro- 
dynia;— one  an  inflammatory  disease,  the  other  a  non-inflammatory  dis- 
ease— which  is  it  ?  A  physical  examination,  it  may  be  said,  will  at  once 
discriminate  one  from  the  other.  But  suppose  the  doctor  has  been  sum- 
moned at  the  very  onset  of  the  attack,  when  the  signs  are  undeveloped, 
the  pain  on  moving  the  chest  is  a  symptom  common  to  both  diseases; 


22  TEMPERATURE    OF    FEVER. 

no  doubt  con2,-li,  present  in  pleuris}^  may  be  absent  in  pleurodynia;  but 
pleurodynia  may  occur  in  a  patient  with  slijjht  catarrh  of  the  bronchial 
tubes,  and*  one  would  not  venture  to  base  his  distinction,  Ijetween  these 
diseases,  simply  on  the  presence  or  absence  of  cough.  The  thermometer 
alone  solves  the  difficulty.  If  the  attack  is  pleurisy,  an  inflammatory 
disease,  there  is  fever  (elevation  of  temperature),  whereas  if  the  attack  is 
pleurodynia,  a  non-inflammatory  disease,  fever  is  absent. 

In  studying  the  temperature  of  fever,  we  must  notice  the  mode  of 
its  rise  (initial  period),  its  character  whilst  at  its  height,  and  in  a  lesser 
degree,  as  of  less  importance,  its  declination  to  the  standard  of  health. 
The  character  of  the  rise  often  helps  us  to  form  an  opinion  of  the  nature 
of  the  illness.  In  most  febrile  diseases  the  temperature  rapidly  rises, 
reaches  its  acme  in  twelve  to  twenty-four  hours.  This  rapid  rise  occurs 
in  the  fever  of  most  inflammations,  and  of  typhus,  scarlet  fever,  measles, 
erysipelas,  etc.  Where  the  rise  is  sudden  and  rapid,  the  onset  of  the 
symptoms  is  equally  sudden  and  accentuated,  and  the  rise  in  the  tempera- 
ture is  generally  accomjianied  by  chills  or  rigors;  or,  as  in  typhus  and 
pneumonia,  by  a  single  severe  rigor.  This  sudden  and  rapid  rise,  being 
common  to  so  many  attacks,  is  of  little  diagnostic  use  beyond  serving  to 
exclude  those  diseases  in  which  the  invasion  is  more  gradual. 

On  the  other  hand,  in  some  diseases,  the  temperature  rises  more  grad- 
ually and  takes  three  or  more  days  before  it  attains  its  maximum.  This 
happens  in  most  cases  of  tuberculosis  and  in  almost  all  cases  of  typhoid 
fever,  and  sometimes  in  rheumatism  and  pleurisy.  This  gradual  rise  of 
temperature  is  therefore  suggestive  of  the  invasion  of  these  diseases,  and 
if  there  is  no  joint  pain,  the  case  is  likely  to  prove  either  typhoid  fever  or 
tuberculosis,  diseases  which  often  closely  simulate  each  other  so  closely 
at  the  commencement  as  to  baffle  the  discrimination  of  the  most  experi- 
enced. As  in  diseases  with  slow  invasion  of  the  fever,  the  doctor  is  seldom 
summoned  till  the  temperature  has  become  well  developed,  he  has  not 
often  the  opportunity  of  ascertaining  how  it  has  comported  itself  at  the 
beginning  of  the  attack.  Hence,  at  this  stage,  the  temperature  is  seldom 
a  serviceable  guide;  the  mode  of  its  rise  must  be  estimated  from  the  slow 
or  quick  onset  of  the  symptoms. 

From  the  course  the  temperature  runs  during  the  time  the  fever  is  at 
its  height,  we  learn  much  more  than  from  the  mode  of  its  onset.  At 
this  juncture  we  must  regard  the  height  of  the  thermometer,  the  extent 
of  the  daily  variations,  and  the  duration  of  the  fever.  The  height  of  the 
temperature  with  its  daily  variations  measures  the  severity  of  the  attack. 
The  greater  the  daily  variations  the  more  favoraljle»tlie  case.  The  high 
temperature,  as  we  have  seen,  immediately  and  directly  depresses  all  the 
functions,  and  further  indirectly  lowers  them  by  producing  degeneration 
of  all  the  tissues;  these  effects  of  course  being  manifested  in  proportion  to 
the  height  of  the  temperature.  Hence  they  are  far  more  marked  in  cases 
when  the  temperature  all  day  keeps  high,  than  in  cases  when,  during 
many  hours,  the  temperature  is  but  little  or  not  at  all  raised  above  the 
limits  of.  health.  A  temperature  of  105°  always  marks  a  severe  attack  of 
any  disease,  especially  if  the  diurnal  variation  is  very  slight,  A  tempera- 
ture above  105°  threatens  considerable  danger;  and  from  a  temperature  of 
107°  patients,  unless  treated  by  cold  baths,  very  seldom  recover.  A  tem- 
perature of  110°  to  112°,  unless  it  yields  to  the  application  of  cold,  is  very 
quickly  fatal. 

In  the  early  days  of  the  clinical  thermometer  it  was  taught  that  in 


TEMPERATURE    OF    FEVER.  23 

some  diseases,  as  in  typhoid,  tlie  temperature  always  readied  a  charac- 
teristic heiglit,  so  that  in  a  given  case,  if  by  the  fourth  day  the  temperature 
failed  to  reach  103.5°  Fall,  the  case  was  said  to  be  not  one  of  typhoid 
fever.  This  absolute  rule  a  more  extended  experience  has  shown  to  be 
erroneous.  Typhoid  and  other  fevers  may  run  their  course  with  any  tem- 
perature above  the  normal  standard.  Some  writers,  indeed,  go  so  far  as  to 
maintain  that  typhoid  fever  may  exist  without  any  abnormal  tempera- 
ture, and  if  typhoid,  they  say,  why  not  other  "fevers"?  Still  it  must 
be  admitted  that  the  temperature  is  a  serviceable  guide  in  the  discrimina- 
tion of  diseases.  For  example,  in  the  majority  of  cases  of  typhus  and 
typhoid  fever,  measles  and  inflammations,  the  temperature  reaches  103'^, 
and  certainly  if  the  temperature  never  exceeds  lOl""  then  probably  the  case 
is  not  typhoid,  typhus,  scarlet  fever,  measles,  nor  any  important  acute 
inflammation.  Sometimes  the  thermometer  greatly  assists  us  in  discrimi- 
nating measles  and  scarlet  fever  from  German  measles  (rotheln).  Thus, 
in  German  measles,  the  patient  often  complains  of  sore  throat,  and  some- 
times its  rash  is  so  like  the  rash  of  scarlet  fever,  and  sometimes  so  like 
the  rash  of  measles,  that  simply  by  the  aspect  it  is  difficult  or  impossible 
to  distinguish  them.  In  this  dilemma  the  temperature,  though  not  an 
absolute  proof,  affords  strong  presumptive  evidence;  thus  in  German 
measles  the  temperature  generally  is  scarcely  or  very  slightly  raised,  not 
higher  than  100°  or  101°,  Avhilst  in  measles  and  in  scarlet  fever,  in  the 
great  majority  of  cases,  the  temperature  runs  higher  than  this. 

The  course  of  the  temperature  wdien  at  its  height  indicates,  as  I  have 
said,  not  only  the  severity  of  the  attack,  but  also  helps  us  likcAvise  to  dis- 
tinguish its  duration.  If  the  te^uperature  is  high,  and  the  daily  variations 
are  slight  or  non-existent,  a  severe  attack  threatens,  sure  to  persist  longer 
than  a  case  with  considerable  daily  falls  in  the  temperature.  The  infor- 
mation thus  obtained  is  especially  instructive  in  typhoid  fever,  for  if  dur- 
ing the  second  week  there  are  daily  great  variations,  we  have  reason  to 
hope  that  the  disease  may  terminate,  possibly  on  the  fifteenth,  though 
more  probably  on  the  twentieth  day;  but  if  during  the  second  week  the 
daily  variations  are  but  slight,  then  the  fever  will  probably  last  twenty- 
five  or  thirty  days. 

When  the  temperature  has  remained  persistently  high,  the  occurrence 
of  morning  falls  shows  the  beginning  of  the  decline  of  the  disease. 

The  duration  of  tlie  fever  helps  us  to  detect  the  nature  of  the  disease; 
and  indeed  in  obscure  cases  it  often  greatly  aids  the  diagnosis.  In  most 
inflammations,  in  scarlet  fever,  in  measles,  the  fever  usually  passes  away 
by  the  fifth  or  tenth  day,  and  in  typhus  on  the  fourteenth  or  fifteenth 
day.  If  the  fever  persists  beyond  this  time  it  is  fair  to  conclude  that  we 
have  not  to  deal  with  one  of  these  diseases;  but  as,  in  the  majority  of 
instances,  they  are  easily  diagnosed  early  in  their  course,  it  is  evident  that 
in  such  cases  the  duration  oi^  the  fever  is  of  little  practical  use;  but  by 
enabling  us  to  discriminate  between  typhoid  and  tuberculosis  and  Ijetween 
the  diseases  causing  chronic  fever,  the  duration  of  the  fever  does  give  us 
very  trustworthy  and  important  evidence. 

In  some  cases  of  typhoid  fever,  the  symptoms  are  not  sufficiently 
marked  to  enable  the  doctor  to  decide  whether  the  case  is  one  of  typhoid 
fever,  tuberculosis,  or  phthisis.  If  the  fever  goes  on  beyond  thirty  days 
then  probably  the  patient  sutlers  from  consumption;  and  each  additional 
day  of  fever  strengthens  this  conclusion.  In  most  cases  of  phthisis, 
before  the  thirtieth  day,  the  lungs  or  other  organs  will,  it  is  true,  gener- 


24 


CHRONIC    FEVER. 


ally  manifest  the  nature  of  the  ilhiess;  hut  not  unfrequently  the  fever  of 
consumption  may  persist  thirty  days  or  more  without  the  concurrence  of 
any  characteristic  physical  signs  or  symptoms  of  its  existence,  AVhen  I 
come  to  speak  of  chronic  fever  I  shall  point  out  with  more  particularity 
that  sometimes  the  thermometer  will  enable  us  to  detect  consum})tion 
earlier  than  by  the  combined  aid  of  the  symptoms  and  the  physical  signs. 

Any  sudden  and  considerable  temperature  variation  generally  fore- 
bodes some  complication;  and  a  sudden  and  considerable  rise,  always. 
A  sudden  and  considerable  fall  may,  of  course,  indicate  the  natural  ter- 
mination of  the  attack,  for  in  many  diseases  the  temperature  falls  very 
rapidly;  in  pneumonia  notably,  it  is  not  uncommon  for  the  temperature 
in  twelve  hours  to  suljside  from  105°  to  the  normal  standard. 

A  sudden  and  marked  rise  in  the  course  of  a  disease  foretells  the  onset 
of  some  inflammatory  complication.  On  the  other  hand,  it  is  important 
to  bear  in  mind  that  an  inflammatory  onset,  interposed  in  the  course  of 
a  febrile  disease,  may  not  heighten  the  existing  temperature;  hence  the 
fact  of  the  temperature  running  the  ordinary  course  pertaining  to  the 
original  attack,  does  not  preclude  the  necessity  for  close  watching,  lest  an 
inflammatory  complication  should  supervene.  Thus,  an  attack  of  pneu- 
monia or  of  pleurisy  may  leave  the  temperature  of  pre-existing  fever  un- 
affected. It  is  important  to  recollect  that,  as  a  rule,  the  onset  of  pericar- 
ditis in  acute  rheumatism  does  not  increase  the  fever.  This  is  hardly  to 
be  wondered  at,  seeing  that  when  a  fresh  joint  becomes  implicated  the 
temperature  does  not  alter,  and  inflammation  of  the  pericardium  may  be 
regarded  as  analogous  to  inflammation  of  a  joint. 

A  sudden  and  considerable  fall,  if  not  due  to  the  natural  termination 
of  the  illness,  means  sudden  collapse.  It  is  oftenest  met  with  in  typhoid 
fever,  and  it  means  haemorrhage  into  the  bowels,  or  perforation  of  the 
intestine.  It  must,  however,  be  recollect(3d  that  each  week  in  typhoid 
fever  a  great  morning  fall  often  occurs.  A  fall  equal  to  that  due  to 
ligemorrhage  or  perforation,  may  occu-r  at  any  time,  but  the  fall  with  these 
accidents  is  more  persistent,  and  is  always  accompanied  by  the  symptoms 
of  collapse.  A  sudden  great  fall  with  collapse  and  without  tenderness  of 
the  abdomen,  is  always  very  ominous  of  haemorrhage  into  the  bowel. 
This  ligemorrhage,  though  considerable,  may  yet  be  retained  for  some 
hours  in  the  intestines. 


CHEOXIC   FEVEK. 


In  some  diseases  fever  may  persist  for  weeks  or  months,  and  by  its 
very  duration  helj)  the  diagnosis.  It  is  true  that  in  most  cases,  whilst  the 
fever  has  lasted  only  a  short  time,  perhaps  only  a  few  days,  the  other 
symptoms  reveal  the  nature  of  the  disease;  but  not  unfrequently  the 
nature  of  the  malady  remains  for  a  long  time  obscure,  and  then  the  per- 
sistence of  the  fever  is  an  important  help  to  the  diagnosis. 

Between  acute  and  chronic  fever  there  is  no  sharp  line  of  demarcation. 
Certain  acute  diseases,  for  instance,  typhoid  fever  and  pleurisy,  may  each 
run  more  than  thirty  days;  whilst,  on  the  other  hand,  febrile  diseases,  like 
deep-seated  abscesses  and  consumption,  which  often  continue  several  Aveeks 
or  months,  or  even  longer,  may  run  a  short  course  of  only  a  fortnight  or 
three  weeks. 


CHRONIC    FEVER.  25 

Since  most  acute  illnesses,  even  typhoid  fever  and  pleurisy,  which 
persist  longer  than  others,  come  to  an  end,  in  the  great  majority  of  cases, 
before  the  thirtieth  day,  we  may  take  that  as  the  limit  of  acute  fever. 

Chronic  fever  occurs  in  jjhthisis,  abscess,  syphilis,  ague,  rheumatism, 
in  most  cases  of  leucocythfemia,  lymphadinosis,  pernicious  ansmia  and 
chronic  pyaemia,  including  malignant  endocarditis. 

As  in  acute  diseases,  so  in  acute  and  subacute  phthisis,  the  tem- 
perature is  a  fairly  accurate  measure  of  the  activity  of  the  disease.  In 
other  words,  there  occurs  a  daily  elevation  of  temperature  of  the  body, 
in  most  cases  in  which  a  formation  of  tubercle  is  taking  place  in  any  of 
its  organs.  This  elevation  is  an  index  of  the  activity  of  the  disease; 
the  fluctuations  of  temperature  indicating  corresponding  fluctuations 
in  the  rate  of  the  disease. 

One  exception,  however,  I  must  mention  to  the  above  general  rule. 
In  tubercular  meningitis,  it  is  by  no  means  uncommon,  though  certainly 
it  is  not  the  rule,  for  the  temperature  to  remain  normal  throughout  the 
course  of  the  attack ;  or  at  all  events  during  most  of  its  later  stages.  In 
some  cases,  for  a  short  period,  the  temperature  is  slightly  elevated,  and 
then  becomes  natural,  or  falls  even  below  the  normal  point.  In  by  far 
the  greater  number  of  instances  the  temperature  is  elevated,  sometimes, 
indeed,  mounting  to  105°  to  108°  Fall. 

It  has  been  asserted  that,  during  acute  miliary  tuberculosis  of  the 
lungs,  the  temperature,  in  rare  instances,  may  remain  normal.  AYith 
regard  to  this  statement,  I  believe  that  the  deposit  of  tubercle  has  gone 
on  by  very  slight  and  scarcely  appreciable  increments;  or  has  become 
obsolescent  at  the  time  the  temperature  was  first  taken,  so  that  the  fever 
stage  was  overlooked.  It  must  be  admitted  that,  in  some  very  chronic 
cases  of  phthisis,  pneumonia,  the  disease  advances  too  slowly,  and  the 
deposit,  at  any  one  time,  is  too  slight  to  be  adequate  to  elevate  the  tem- 
jDcrature  unless  to  a  very  small  extent. 

Thus,  we  meet  with  cases  in  which,  some  time  before  death,  the  tem- 
perature was  always  natural,  yet  the  post-mortem  examination  reveals 
much  fibroid  degeneration  from  old  standing  tubercle  or  catarrhal  pneu- 
monia; and  adjacent  to  the  fibroid  portions,  in  the  otherwise  healthy 
lung  tissue,  we  see  a  few  recent  miliary  tubercles  easily  counted,  or  a 
few  small  patches  of  recent  tubercular  pneumonia.  Indeed,  in  these 
diseases,  we  meet  with  every  degree  of  activity  to  which  the  temperature 
corresponds.  In  some  cases  the  disease  advances  so  slowly  that  the  tem- 
perature is  scarcely  raised,  and  we  should  naturally  expect  so  very  slight 
an  amount  of  morbid  action  would  be  insufficient  to  raise  the  tempera- 
ture appreciably.  Where  there  is  no  elevation  of  the  temperature,  we 
may  conclude  that  the  progress  of  the  disease  is  almost  insignificant; 
although  the  patient  is  exposed  to  the  lurking  danger  that,  from  some 
slight  cause,  this  comparatively  harmless  condition  may  be  aggravated 
into  a  severe  and  dangerous  attack. 

The  apparent  exceptions  to  this  statement  can,  I  think,  be  ex^jlained 
in  this  way : — 

With  phthisis,  as  with  other  causes  of  chronic  fever  where  the  disease 
goes  on  but  slowly,  it  must  be  borne  in  mind  that  the  fever  may  last  only 
a  few  hours  in  the  day,  sometimes  not  more  than  three  or  four,  sometimes 
only  in  the  middle  of  the  day,  so  that  a  morning  and  evening  observation 
may  miss  the  fever,  and  may  lead  to  the  erroneous  conclusion  that  the 
patient  was  fever-free. 


26  CIIEONIC    FEVER. 

Another  source  of  error  arises  from  the  mode  of  taking  the  tempera- 
ture. Phthisical  patients  are  often  very  thin,  and  hence  the  bnlh  of  the 
thermometer,  when  pLaced  in  the  axilla,  instead  of  being  embraced  all 
round  by  the  tissues,  lies  half  exposed  in  a  hollow  cavity,  and  never  ac- 
quires the  temperature  of  the  body.  This  source  of  error  is,  moreover, 
often  coupled  with  another.  When  the  patient  is  perhaps  dressed,  or  has 
had  his  arms  out  of  bed,  and  his  axilla  has  become  cooled,  it  would  take 
half  an  hour  or  an  hour  before  the  skin  of  the  exposed  parts  would  recover 
its  lost  heat  so  as  to  mark  the  temperature  of  the  body.  Over  and  over 
again,  in  hospital  practice,  I  have  been  told  that  the  temperature  was 
normal,  or  even  below  normal,  but  on  taking  the  temperature  under  the 
tongue,  or  in  the  rectum,  have  found  the  patient  suffering  from  several 
degrees  of  fever. 

In  some  cases,  it  must  be  admitted,  there  ajopears  to  be  a  dispropor- 
tion between  the  progress  of  the  disease  and  the  temperature.  This  dis- 
proportion occurs,  I  believe,  only  in  cases  of  long  standing,  and  when 
the  disease  has  lasted  a  considerable  time,  perhaps  it  produces  less  eleva- 
tion than  at  first,  the  patient  becoming  accustomed  to  the  disease,  and, 
as  in  the  case  of  medicines,  it  produces  less  constitutional  effect.  As 
the  result  of  my  experience,  I  am  inclined  to  think  that  the  same  amount 
of  disease  in  middle-aged  and  in  elderly  people  produces  less  fever  than 
in  the  young,  and  that  less  fever  is  produced  toward  the  end  of  the  dis- 
ease, when  the  patient's  powers  are  greatly  depressed. 

The  temperature  is  a  more  accurate  indication  of  the  activity  of  tuber- 
culosis or  of  catarrhal  pneumonia,  than  either  the  physical  signs  or  the 
symptoms.  Thus,  only  a  considerable  increase  in  the  amount  of  disease 
can  be  detected  by  physical  signs;  and  in  disseminated  tuberculosis, 
where  the  granulations  are  pretty  equally  scattered  throughout  the  lungs, 
and,  indeed,  often  through  most  of  the  organs  of  the  body,  there  may 
be  entire  absence  of  physical  signs.  Thus,  it  is  apparent  that  the  physi- 
cal signs,  even  in  very  acute  cases,  only  give  ns  evidence  of  the  continu- 
ance of  the  disease  after  the  lapse  of  a  considerable  interval:  while  it  has 
been  shown  that  in  almost  all  cases  there  is  an  elevation  of  temperature 
during  the  formation  of  tubercle,  and  that  this  elevation  being  propor- 
tionate to  the  activity  of  the  disease,  the  thermometer  will,  unerringly 
at  any  time,  point  out  the  continuance  and  the  amount  of  disease,  except 
indeed,  in  those  very  chronic  cases  where  the  amount  of  tuberculization 
or  of  catarrhal  pneumonia  is  slight  and  almost  insignificant.  When  it 
is  thus  borne  in  mind  that  only  considerable  deposits  in  the  lungs  can 
be  detected  by  physical  signs,  while  even  a  small  amount  will  raise  the 
temperature  even  considerably  for  some  time,  it  becomes  evident  that 
the  thermometer  will  give  a  far  better  estimate  of  the  amount  of  mis- 
chief than  the  physical  signs.  Moreover,  after  the  cessation  of  tubercu- 
losis or  catarrhal  pneumonia,  consolidation  from  the  fibroid  lung  remains, 
and  from  the  physical  signs  it  is  impossible  to  tell  the  condition  of  such 
a  lung,  to  tell  whether  disease  is  progressing  or  not;  the  temperature 
will  answer  the  question  for  us.  If  the  temperature  is  natural  at  all 
joeriods  of  the  day,  we  may  safely  conclude  after  a  few  days  that  active 
disease  has  very  nearly  or  entirely  ceased. 

It  must  be  recollected  that  the  fever  is  a  measure  of  the  increase  of 
the  tuberculization,  not  of  the  damage  already  done.  Thus  the  disease 
may  cease  to  extend  and  the  tem})erature  become  normal;  but  the  ex- 
tensive consolidation  of  the  lung  may  begin,  and  continue  to  soften  and 


CHRONIC    FEVER.  27 

lead  to  cavities.  Hence,  because  the  fever  ceases,  and  the  formation  of 
fresh  tubercle  of  catarrhal  pneumonia  ceases,  we  must  not  conclude  that 
the  patient  is  free  from  danger,  for  the  softening  and  suppuration  may 
lead  to  fatal  exhaustion. 

Observation  of  the  temperature  often  saves  us  from  error,  and  ena- 
bles us  to  form  a  correct  judgment  of  the  true  condition  of  the  patient. 
A  patient  with  only  a  moderate  amount  of  fever,  say  102°  to  108°,  last- 
ing only  a  part  of  the  day,  has  been  losing  weight  and  growing  weaker. 
She  goes  to  the  country,  her  appetite  and  assimilative  powers  increase, 
she  grows  much  heavier  and  stronger,  and  regains  much  of  her  lost  color. 
On  a  physical  examination  of  the  chest,  we  detect  no  increase  in  the 
physical  signs,  but  during  the  whole  time  the  temperature  has  risen  to 
its  accustomed  height,  102°  to  103°,  showing  that  the  disease  still  pro- 
gresses, but  that  the  improved  appetite  has  more  than  obviated  the  waste 
from  the  fever.     In  other  words,  nutrition  is  in  excess  of  waste. 

On  the  other  hand,  we  must  be  careful  not  to  pay  too  much  heed  to 
the  temperature,  nor  to  build  our  prognosis  entirely  on  it.  For  it  often 
happens  that  there  is  a  marked  disproportion  between  the  general  symp- 
toms and  the  degree  of  tuberculization,  or  the  rate  of  formation  of  the 
products  of  catarrhal  pneumonia.  A  patient,  with  very  slow  progressive 
phthisis  and  moderate  fever,  associated  with  the  very  slight  physical 
signs  which  develop  slowly,  has  a  flagging  appetite  and  he  quickly 
wastes;  or  sometimes  a  good  appetite,  but  assimilation  is  at  fault,  and 
so,  in  spite  of  plenty  of  nourishment,  he  progressively  grows  thinner 
and  thijiner.  Therefore,  we  must  regard  not  only  the  temperature  as  a 
measure  of  the  progress  of  the  tuberculization,  but  must  likewise  take 
into  consideration  the  patient's  appetite  and  weight,  the  occurrence  of 
complication,  as  diarrhoea  from  ulceration  of  the  intestines,  the  presence 
of  albumen  in  the  urine  from  fatty  kidiiey,  and  whether  albuminoid  de- 
generation has  implicated  the  liver,  spleen,  or  kidneys. 

Fibroid  phthisis  remains  now  to  be  considered.  Tubercle,  behaving 
as  an  irritant,  induces  increase  of  the  connective  tissue  with  formation 
of  fibroid  bands,  which  cause  the  lung  to  become  tough  and  fibrous. 
This  condition  of  lung  often  co-exists  with  progressive  formation  of 
tubercle.  When  the  further  progress  of  these  two  diseases  is  stayed  this 
fibroid  condition  is  left.  This  is  the  most  common  cause  of  a  fibroid 
lung,  but  it  may  originate  in  a  different  way.  The  temperature  in  fibroid 
phtliisis  varies.  In  some  cases  it  is  quite  natural,  or  if  the  health  is  much 
depressed,  it  is  even  below  normal.  In  those  cases  which  go  on  to  cure  it 
is  natural.  The  walls  k.^  the  cavities  become  dry,  rhonchus  and  expecto- 
ration cease,  the  cavities  slowly  contract,  and  the  patient  recovers  health 
and  strength;  but  the  induration,  very  obvious  on  a  physical  examina- 
tion, still  remains.  Now  in  a  case  like  this,  the  temperature  often  be- 
comes of  the  greatest  importance.  A  patient  presents  himself  with  a 
history  of  a  previous  attack  of  phthisis.  We  find  marked  evidences  of 
consolidation  of  the  apices  of  the  lungs.  The  jDatient's  health  is  good, 
his  appetite  and  digestion  vigorous.  Are  these  physical  signs  simply 
due  to  his  jirevious  illness,  or  is  the  phthisis  progressing?  If  his  tem- 
perature remains  for  several  days  quite  normal,  we  may  conclude  either 
that  there  is  no  progressive  tuberculization,  or  that  it  is  very  small  in 
amount ;  as  we  shall  shortly  see,  there  may  be  probably  a  slight  amount 
of  catarrhal  pneumonia,  without  a  rise  of  temperature. 

In  other  cases  of  fibroid  phthisis,  even  when  the  formation  of  tuber- 


28  CHRONIC    FEVER. 

cle  hiis  ceased,  we  may  have  a  slight  daily  rise  in  the  temperature  to  100° 
or  even  101°,  due  to  the  suppuration  in  the  cavities.  This  suppuration 
can,  of  course,  raise  the  temperature  just  like  suppuration  in  an  open 
discharging  psoas,  or  other  discharging  abscess. 

Thepersistence  of  a  slight  amount  of  fever  does  not,  therefore,  con- 
clusively prove  the  continuance  of  the  tuberculization.  Nor,  on  the 
other  hand,  I  think,  can  we  possibly  say  that  while  the  temperature  is 
normal  the  tuberculization  may  not  be  in  a  very  slow  degree  extending. 
Clinical  experience  shows  us  that  a  very  small  formation  of  tubercle  or 
of  catarrhal  pneumonia  may  occur  without  a  rise  of  temperature. 

We  very  often  meet  with  mixed  cases,  where  the  upper  part  of  the 
lung  has  become  fibroid,  while  active  disease  goes  on  in  the  lower  part. 
In  cases  like  this  the  temperature  is  raised  in  proportion  to  the  activity 
of  the  acute  disease.  If  the  disease  progresses  slowly,  and  raises  the 
temperature  to  only  100°  to  101°  Fall.,  it  is  difficult  to  determine  whether 
the  fever  indicates  an  extension  of  the  tuberculization,  or  of  catarrhal 
pneumonia,  or  is  due  to  suppuration  in  the  cavities. 

As  in  acute  phthisis,  so  in  chronic,  with  fibroid  lung,  we  must  be 
careful  not  to  pay  sole  regard  to  the  temperature.  Thus  the  formation 
of  tubercle  ceases,  and  the  temi^erature  becomes  normal;  but  before  this 
comes  to  pass  the  health  may  become  damaged  beyond  recovery,  or  the 
kidneys  may  become  seriously  implicated,  or  through  lack  of  appetite 
and  digestive  power,  the  patient  may  wastef  away  and  die;  or  the  uncer- 
tain weather  incidental  to  this  country  may  irritate  the  cavities  and  keep 
up  continuous  suppuration,  which  drains  away,  exhausts  the  strength, 
and  destroys  the  patient  by  j^roducing  wide-spread  albuminoid  degen- 
eration. 

Therefore,  in  a  case  of  fever-free  phthisis,  we  must  take  into  consider- 
ation the  general  condition  as  well  as  the  temperature.  When  appetite, 
digestion,  and  assimilation  are  good,  then  the  patient  quickly  regains 
strength  and  health.  Therefore,  in  forming  an  ojDinion  of  a  case,  we 
must  regard  the  temperature,  the  appetite,  and  the  weight. 

The  temperature  in  phthisis  affords  us  still  further  guidance.  A 
patient  throws  up  a  large  quantity  of  blood  from  the  lungs,  and  the 
grave  questions  arise, — is  the  haemorrhage  due  to  the  congestion  which 
accompanies  acute  phthisis  ?  or  is  it  independent  of  phthisis  ?  If  the 
temperature  is  normal  we  may  at  once  exclude  acute  phthisis;  and  if  the 
temperature  remains  normal  we  conclude  that  the  hemoptysis  has  not 
excited  catarrhal  pneumonia.  Again,  a  patient  having  recovered  from  a 
previous  attack  of  phthisis,  which  has  left  well-marked  physical  signs, 
spits  a  little  blood.  Does  this  show  that  he  is  again  the  subject  of  pro- 
gressive phthisis,  or  is  the  bleeding  due  to  ulceration  of  the  avails  of  an 
old  cavity?  Here  the  temperature,  if  normal,  and  continuing  normal, 
enables  us  to  conclude  that  the  lia3moptysis  does  not  depend  on  another 
attack  of  phthisis. 

The  thermometer  in  many  cases  is  of  still  more  signal  service  in  giv- 
ing early  and  significant  warning.  By  its  aid  we  can  often  diagnose 
phthisis,  before  we  can  detect  any  physical  signs,  and  at  a  period  when 
symptoms  themselves  are  insufficient  to  justify  a  grave  diagnosis.  A 
patient  suffers  from  chronic  fever.  What  is  the  cause  of  it  ?  So  far  as 
we  at  present  know  chronic  fever  occurs  only  in  tuberculosis,  cat-arrhal 
pneumonia,  large  abscesses,  rheumatism,  ague,  occasionally  in  syphilis, 
in  some  cases  of  leucocythgemia,  in  lymphadenoma,  and  in  pernicious 


CHRONIC    FP^VER.  29 

anasmia  and  chronic  pyaemia.  The  diagnosis  of  ague  and  rheumatism  is 
rarely  difficult,  the  characteristic  symptoms  in  most  cases  rendering  their 
identification  quite  easy.  Large  superficial  abscesses  j^resent  no  diffi- 
culty, but  it  may  not  be  so  easy  to  detect  deep-seated  abscesses;  and  in 
some  cases  the  diagnosis  is  for  a  considerable  time  impossible.  As  a  rule, 
however,  they  give  more  or  less  jDain,  often  to  a  considerable  degree,  in 
the  neighborhood  of  the  abscess  or  over  the  spine-,  moreover,  a  tumor  is 
generally  detectable  after  the  fever,  if  at  all  high,  has  lasted  a  few  weeks. 
Local  symptoms,  too,  as  pain  on  movement,  stiffness,  lameness,  etc.,  will, 
in  most  cases,  point  out  the  nature  of  the  disease.  Sometimes,  however, 
deep-seated  abdominal  abscesses  run  a  much  more  chronic  course,  the 
temperature  assuming  then  the  character  so  common  in  fibroid  lung; 
thus  the  temperature  rises  to  101°,  even  perhaps  to  102°,  and  daily 
mounts  to  this  height  for  a  few  days,  then  becomes  natural  for  a  varia- 
ble time,  but  some  cause,  as  over-exercise,  once  mor^  excites  the  fever, 
and  the  temperature  again  stands  high  for  a  week,  a  fortnight,  or  longer. 
It  is  very  often  difficult  to  determine  the  nature  of  the  disease,  so  as  to 
exclude  phthisis.  True,  there  are  no  pulmonary  physical  signs,  but 
these  may  be  absent  in  phthisis,  whilst  the  local  symptoms  may  be  too 
few  to  justify  the  diagnosis  of  abscess.  Having  but  a  limited  experience 
of  deep-seated  subacute  abscesses  I  would  wish  the  following  remarks 
to  be  accepted  with  caution.  In  general  there  is  pain  in  the  abdomen, 
not  constant,  but  brought  on  by  slight  walking;  sometimes  there  are 
marked  dyspeptic  symptoms,  amongst  Avhich  flatulence  predominates.  A 
slight  daily  rise  of  temperature  continued  for  a  considerable  time,  or 
running  the  irregular  course  just  described,  if  accompanied  by  deep  pain 
and  tenderness  in  the  abdomen,  the  lungs  being  free  from  evidences  of 
disease,  will,  I  am  inclined  to  believe,  justify  the  suspicion  of  a  deep-seated 
subacute  abscess.  These  rules  at  all  events  have  enabled  me  to  diagnose 
doubtful  abscesses,  when,  unaided  by  the  thermometer,  their  detection 
seemed  impossible.  I  lean  to  the  belief  that,  with  these  abdominal  ab- 
scesses, the  fever-free  periods  not  unusually  ]3ersist  longer  than  in  suba- 
cute phthisis ;  moreover,  the  rise  can  sometimes  be  traced  distinctly  and 
repeatedly  to  exercise,  a  bout  of  fever,  accompanied  by  an  increase  in  the 
other  symptoms,  occurring  after  each  undue  exertion.  When  an  abdomi- 
nal tumor  is  detectable  by  the  hand,  or  when  there  are  evidences  of  dis- 
eased spine,  then,  of  course,  the  diagnosis  is  far  more  easy. 

Again,  a  large  discharging  sore,  or  a  discharging  psoas  or  iliac  abscess, 
frequently  produces  a  course  of  fever  like  that  described  under  subacute 
and  chronic  phthisis.  In  some  cases  there  is  a  slight  daily  elevation 
lasting  for  months,  in  other  cases  the  abnormal  temperature  continues 
for  only  a  few  days,  or  lasts  one  or  two  weeks,  and  then  for  a  short  time 
falls  again,  and  this  alternation  may  be  repeated  for  a  considerable  time. 
Here  the  diagnosis  is  easy,  for  there  is  a  discharging  sore  with  absence 
of  pectoral  physical  signs  or  symptoms. 

In  cases  of  constitutional  syphilis  with  chronic  fever,  the  diagnosis  in 
many  cases  is  more  difficult,  and,  unfortunatch^  little  of  this  subject  is 
known  at  present.  The  temperature  may  be  high,  rising  to  103°  and 
104°  Fall,  daily;  the  morning  remissions  are  usually  great,  the  tempera- 
ture often  falling  to  98°.  In  these  respects  sy2:)hilitic  fever  corresponds 
to  moderately  severe  cases  of  phthisical  fever,  but  distinct  and  easily 
recognizable  constitutional  symptoms  generally  set  in  concurrently  with 
the  fever.     The  disease  may  assume  the  rheumatic  form;  and  thus  the 


30  CHRONIC  fp:ver. 

diagnostic  difficulty  Avill  lie.  not  between  i)lithisis  and  syphilis,  but  be- 
tween simple  acute  rheumatism  and  syphilis.  In  some  cases  the  diagno- 
sis has  seemed  impossible  until,  on  the  administration  of  iodide  of  potas- 
sium, the  temperature  at  once  became  normal,  or  declined  gradually, 
reaching  the  temperature  of  health  in  one  or  two  weeks.  Very  large 
doses  may  be  required. 

In  syphilitic  affection  of  the  lung,  the  diagnosis  may  be  impossible, 
though  other  manifestations  of  syphilis  may  suggest  the  correct  diagno- 
sis, which  becomes  confirmed  on  the  rapid  improvement  produced  by 
large  doses  of  potassium  (iodide). 

Assuming  the  exclusion  of  the  foregoing  causes  of  fever,  the  question 
arises — How  long  must  the  elevation  of  temperature  persist  before  we 
can  w4th  probability  suspect  j^hthisis,  in  cases  free  from  physical  signs 
or  characteristic  symptoms,  as,  for  instance,  haemoptysis  ?  From  ten  to 
twenty  days,  I  think,  each  day  facilitating  and  strengthening  the  diagno- 
sis. In  the  first  few  days  the  diagnosis  is  well-nigh  impossible,  but  each 
successive  day  serves  to  exclude  sources  of  error.  Thus,  on  the  second 
day,  if  the  rise  is  due  to  scarlet  fever,  its  characteristic  rash  ought  to 
appear;  if  due  to  small-pox,  the  rash  should  apjiear  on  the  tliird  day;  if 
in  measles,  about  the  fourth;  and  in  typhus,  on  the  fifth  day.  Before 
this  time,  if  the  rise  is  due  to  acute  inflammation  of  the  brain,  lungs, 
kidney,  etc.,  characteristic  symptoms  and  physical  signs  will  have  set  in. 
In  most  cases  of  typhoid  fever  the  rose  spots  w^ill  appear  between  the 
eighth  and  tenth  day;  and  at  this  stage  we  may  exclude  most  cases  of 
simple  inflammation,  which  usually  decline  before  the  tenth  day,  when 
the  fever  ceases.  Thus,  on  the  tenth  day,  or  thereabouts,  assuming,  as 
we  have  said,  the  exclusion  of  the  other  causes  of  chronic  fever,  the 
diagnosis  lies  between  tuberculosis  and  t^qihoid  fever.  In  the  early 
stages  the  discrimination  of  one  from  the  other  is  difficult,  and  may  in- 
deed be  impossible.  Each  begins  gradiially,  and  is  not  usually  ushered 
in  with  chills,  convulsions,  or  rigors;  nor  have  we  ordinarily  to  assist 
our  judgment,  distinctive  symptoms,  like  the  back  and  headache  of  small- 
]30x,  the  sore-throat  of  scarlet  fever,  the  coryza  and  cough  in  measles, 
before  the  advent  of  the  characteristic  rashes.  It  is  true  that  in  the  be- 
ginning of  many  cases  of  typhoid  fever,  before  the  appearance  of  the 
rash,  there  is  diarrhoea  and  headache;  but  though  these  symptoms  point 
strongly  to  typhoid  fever,  yet  they  m;iy  be  present  at  the  commencement 
of  acute  tuberculosis.  Moreover,  diarrhoea  and  even  headache  may  be 
absent  in  typhoid  fever.  But  by  the  tenth  or  the  fifteenth  day  the  diag- 
nosis in  most  cases  becomes  easy;  still  it  must  be  admitted  that  now  and 
then  we  encounter  perplexing  cases  of  typhoid  fever,  which  render  the 
diagnosis  between  it  and  tuberculosis  or  catarrhal  pneumonia  doubtful 
for  a  much  longer  time;  the  thirtieth  day  once  passed,  should  the  disease 
have  remained  so  long  undetermined,  it  is  in  all  probability  not  typhoid 
fever,  for  this  usually  ceases  either  before  or  at  this  time.  Yet  it  is  well 
knoAvn  that  typhoid  fever  occasionally  lasts  six  wrecks,  or  longer.  In 
children,  the  diagnosis  between  typhoid  fever  and  acute  miliary  tuber- 
culosis is  often  extremely  difficult,  the  symptoms  of  typhoid  being  in 
some  cases  so  ill-defined  that  many  good  observers  refuse  to  consider 
them  to  denote  typhoid  fever,  and  call  them  simple  continued  fever  of 
children.  Many  of  these  cases  are  probably  acute  tuberculosis,  the  de- 
posit ceasing,  and  the  tubercles  becoming  obsolescent  and  harmless.  Of 
course  the  diagnosis  is  difficult  only  when,  in  acute  miliary  tuberculosis 


CHRONIC    FEVER.  31 

and  cutarrhal  pneumonia,  there  are  neither  physical  signs  nor  charac- 
teristic symptoms. 

Again,  after  typhoid  fever,  a  period  of  fever  may  set  in  lasting  six 
"weeks  or  two  months,  the  temperature  becoming  almost  natural,  then 
daily  rising  higher  and  higher  to  101'',  102°,  even  103°,  and  after  about 
four  or  five  days  again  gradually  falling,  this  course  being  often  re- 
peated. Occurring  after  typhoid  fever,  such  a  temperature  does  not 
show  lung  disease.  This  condition  may  co-exist  with  a  clean  tongue,  in- 
crease of  appetite  and  weight,  and  a  steady  amendment  of  the  health. 

It  thus  appears  that  the  temperature  alone  may  enable  us  to  diagnose 
tubercle  phthisis,  in  cases  where  the  physical  signs  and  symptoms  are 
absent,  or  are  too  indefinite  to  assist  the  diagnosis. 

The  following  typical  instances  illustrate  the  usefulness  of  tlie  ther- 
mometer in  doubtful  cases  of  phthisis : 

A  patient  is  taken  rather  suddenly  ill.  His  face  is  flushed,  eyes  bright, 
pulse  quick.  The  temperature  is  very  high.  There  is  no  headache,  no 
delirium,  no  diarrhoea.  So  weak  is  he  that  he  stays  in  bed.  At  the  end 
of  ten  or  fifteen  days  he  remains  much  in  the  same  plight,  but  has 
grown  weaker.  His  tongue  has  become  dry.  There  are  no  typhoid  spots, 
no  diarrhoea,  and  the  stomach  is  not  distended.  He  has  neither  cough 
nor  expectoration,  and  there  are  no  physical  signs  in  the  chest.  For  a 
month  or  five  weeks  he  continues  in  the  same  state,  when  distinct  physi- 
cal signs  at  the  apices  of  the  lungs  appear,  accompanied  by  expectoration, 
and  possibly  slight  hasmoptysis.  Soon  he  begins  to  improve,  the  fever 
grows  daily  less  severe,  his  tongue  becomes  clean,  appetite  slowly  returns, 
cough  diminishes,  and  at  last  both  cough  and  expectoration  cease.  All 
moist  chest  sounds  disappear,  and  at  the  expiration  of  about  two  months 
the  temperature  becomes  natural,  strength  returns,  his  weight  increases, 
although  he  will  always  carry  evidences  of  consolidation  at  the  apices 
of  his  lungs. 

A  woman,  between  30  and  35  years  of  age,  fails  slightly  in  health, 
complains  of  slight  weakness,  is  soon  tired,  but  is  never  ill  enough  to  be 
confined  to  bed.     Her  appetite  is  rather  bad. 

There  is  a  trifling  cough,  and  perhai:)S  on  one  or  two  occasions  the  ex- 
pectoration of  a  slight  streak  of  bright-colored  blood,  so  slight  and  so 
seldom  repeated  that  it  is  hoped  the  blood  may  have  come  from  the  mouth 
or  throat.  There  may  be  a  strong  family  predisposition  to  phthisis. 
!No  physical  signs  are  apparent;  yet  the  temperature,  rising  nightly  to 
101°  or  102°  Fall.,  declares  the  true  nature  of  the  disease,  which,  perhaps, 
in  the  course  of  some  months,  decided  physical  signs  render  too  evident. 
How  important  is  it  to  detect  this  early  and  slight  stage  of  the  disease! 

By  means  of  the  temperature  we  can  diagnose  tuberculosis,  even 
when  during  the  whole  course  of  the  disease  there  are  no  physical  signs 
indicative  of  tubercular  deposit  in  any  of  the  organs  of  the  body,  and 
when  the  symptoms  are  quite  inadequate  to  enable  us  to  form  such  a  di- 
agnosis. Thus,  we  commonly  meet  with  cases  of  acute  miliary  tuberculo- 
sis in  children,  where,  throughout  the  whole  course  of  the  disease,  the 
only  guiding  symptom  is  iDreternatural  heat  of  the  body,  except,  perhaps, 
a  small  amount  of  sonorous  or  sub-mucous  rhonchus,  and  yet  after  death 
most  of  the  organs  of  the  body  are  found  studded  with  miliary  tubercles. 
Again,  we  occasionally  meet  with  patients,  generally  among  children  ten 
or  twelve  years  old,  who  complain  of  pain  in  the  head,  and  whose  man- 
ner is  peculiar,  being  semi-idiotic,  in  whom  the  temperature  daily  rises 


32  DROPSY. 

considerably  for  weeks  or  months,  and  after  death  small  masses  of  yellow 
tubercle,  the  size  of  a  large  pea  or  bean,  are  found  embedded  in  the  sub- 
stance of  the  brain,  with  sometimes  miliary  tubercles  scattered  through 
the  thoracic  and  abdominal  organs. 


ON  DROPSY. 


Ix  health,  nutritive  plasma  escapes  from  the  blood-vessels  into  the 
adjacent  tissues,  and  is  afterwards  absorbed  by  the  lymphatics  and  veins. 
This  transfusion  and  absorption  counterbalance  each  othei*,  and  hence 
only  a  moderate  amount  of  fluid  is  found  in  the  parenchymatous  tis- 
sues. But  if  a  disturbance  arises  in  the  balance  between  these  two  pro- 
cesses, the  parenchymatous  fluid  increases,  producing  dropsy,  or  ana- 
sarca, a  condition  due  either  to  too  large  a  quantity  of  fluid  transfusing 
through  the  blood-vessels,  or  to  deficient  absorption.  Nutritive  plasma 
passes  from  the  blood-vessels  by  filtration,  difl'usion,  or  secretive  attrac- 
tion of  the  tissues  for  the  fluids  in  the  blood.  Dropsy  never  probably 
happens  through  increased  attraction  of  the  tissues  for  the  jDlasma,  but 
generally  on  filtration.  The  amount  of  fluid  escaping  from  the  tissues 
by  filtration  depends  on  the  difference  between  the  pressure  of  fluid  in 
the  blood-vessels  and  in  the  parenchymatous  tissues.  In  health  the 
pressure  of  the  fluid  in  the  blood-vessels  is  higher  than  that  of  the  fluid 
outside  the  capillaries,  and  hence  a  constant  current  of  nutritive  plasma 
flows  through  the  blood-vessels  to  the  tissues  outside  them. 

Most  cases  of  general  dropsy  depend  on  hydremia,  and  this  is  pro- 
duced by  diminished  action  of  the  kidneys,  whereby  the  urine  is  greatly 
diminished  in  quantity,  while  the  patient  takes  the  same  quantity  of 
liquid  into  the  system ;  hence  the  excess  of  ingestion  over  that  eliminated 
through  the  kidneys  accumulates  in  the  blood,  and  produces  hydremia, 
and,  as  Bartels  has  pointed  out,  the  amount  of  dropsy  is  for  the  most  part 
in  projDortion  to  the  diminution  of  urine.  The  inaction  of  the  kidneys 
may  be  j)roduced  in  three  ways — by  disease  of  the  kidneys,  as  Bright's 
disease,  especially  the  acute  and  fatty  kind;  by  diminished  arterial  pres- 
sure in  the  glomeruli  from  general  diminution  of  arterial  pressure  depend- 
ing on  heart  disease;  and  on  retardation  of  the  circulation  through  the 
kidneys  from  venous  congestion  due  to  tricuspid  regurgitation. 

In  those  forms  of  Bright's  disease,  the  fibroid  or  the  albuminoid, 
where  the  quantity  of  urine  is  normal  or  even  excessive,  there  is  no  dropsy, 
while  in  the  acutely  inflamed  or  fatty  kidney,  in  both  of  which  diseases 
the  quantity  of  urine  is  often  greatly  lessened,  the  dropsy  is  often  marked, 
and  almost  always  occurs  when  the  quantity  of  urine  is  notably  dimin- 
ished, while  it  is  absent  in  those  cases  where  the  secretion  of  urine  is  free. 

In  all  valvular  affections  of  the  heart,  and  in  a  weak  heart,  less  blood 
is  propelled  into  the  arterial  system,  and  consequently  arterial  tension  is 
lowered.  This  is  the  result  of  emphysema,  which  hinders  the  passage 
of  blood  through  the  lungs.  It  is  the  result  of  mitral  and  of  aortic  affec- 
tions. To  overcome  the  obstruction  the  heart  undergoes  compensatory 
hypertrophy,  and  if  this  is  perfect  then  arterial  tension  is  kept  up,  but  if 
this  is  imperfect,  or  if  the  left  ventricle  after  hypertrophy  undergoes  de- 
generation, then  arterial  tension  immediately  falls  in  the  glomeruli  as 


DROPSY.  83 

well  as  in  the  body  generally.  Now  the  amount  of  water  that  filters 
through  the  walls  of  the  vessels  in  the  glomeruli  depends  on  the  differ- 
ence of  lateral  pressure  inside  and  outside  the  blood-vessels.  If  arterial 
tension  is  much  reduced,  then  less  water  filters  through  the  vessels,  and 
the  water  accumulates  in  the  blood. 

But  the  quantity  of  urine  dej^ends  not  only  on  the  degree  of  arterial 
tension  in  the  vessels  of  the  glomeruli,  but  also  on  the  rapidity  of  the 
circulation  through  the  kidneys.  If  arterial  tension  is  lowered  then  the 
rate  of  circulation  is  reduced.  But  general  venous  congestion  from  tri- 
cuspid regurgitation  also  lessens  the  rate  of  the  circulation ;  hence  tricus- 
pid regurgitation  in  this  way  tends  to  lessen  the  secretion  of  urine  and 
so  to  produce  hydrasmia.  How  does  hydra3mia  produce  dropsy  ?  The  ques- 
tion canuot  at  present  be  satisfactorily  answered,  but  it  is  often  assumed 
that  the  volume  of  the  blood  being  increased  arterial  pressure  is  aug- 
mented, hence  more  serous  fluid  filters  into  the  parenchyma,  and  filtration 
is  easier  from  watery  than  normal  blood. 

Cohnheim  finds  that  injecting  water  into  the  vessels  of  a  dog  will  not 
cause  dropsy  unless  the  vessels  themselves  become  altered,  and  he  con- 
cludes that  in  anaemia  and  hydremia  the  vascular  walls  undergo  change 
and  so  favor  the  escape  of  fluid  into  the  connective  tissue. 

Dropsy  then  is  in  pro])ortion  to  the  amount  of  hydraemia,  and  the 
amount  of  water  in  the  blood  is  generally  dependent  on  the  action  of  the 
kidneys.  AVe  meet,  however,  with  cases  that  at  first  sight  appear  excep- 
tions to  this  statement,  for  we  see  patients  troubled  with  extensive  and 
progressive  dropsy  who  pass  two,  three,  or  even  four  pints  of  urine  daily; 
but  it  will  generally  be  found  that  these  patients  are  troubled  with  great 
thirst,  and  drink  far  more  tlian  they  void  through  the  kidneys  or  skin, 
and  the  excess  of  their  drink  over  the  quantity  of  urine  accumulates  in 
the  blood,  causing  hydrsemia  and  dropsy. 

Are  we  right,  however,  in  asserting  with  some  writers  that  mere  venous 
obstruction  caniiot  cause  though  it  may  favor  dropsy,  but  that  without 
some  affection  of  the  nervous  system  dropsy  will  not  occur  ?  Thus,  the 
ascending  vena  cava  in  dogs  has  been  tied  without  producing  dropsy  of 
the  posterior  limbs,  but  on  cutting  the  nerves  of  the  sciatic  plexus, 
dropsy  came  on  immediately;  and  as  the  division  of  the  nerves  inside  the 
spinal  canal  (that  is  before  the  vaso-motor  nerves  join  them)  does  not 
produce  dropsy,  it  is  concluded  that  paralysis  of  the  vaso-motor  nerves  is 
the  cause  of  dropsy.  (Kanvier.)  Clinical  facts,  however,  certainly  prove 
that  mere  venous  obstruction  will  cause  dropsy.  Cirrhosis  of  the  liver, 
or  a  tumor  pressing  on  the  vena  porta?,  or  coagulation  in  the  vein  as  it 
enters  the  liver,  will  produce  ascites.  Are  we  to  conclude  that  these  dis- 
eases paralyze  the  vaso-motor  nerves  of  the  abdominal  blood-vessels  ?  I 
think,  then,  we  must  admit  that  mere  venous  congestion  may  cause  dropsy, 
but  that  paralysis  of  the  vaso-motor  nerves  greatly  favors  dropsy. 

Is  the  venous  congestion  consequent  on  tricuspid  regurgitation  suffi- 
cient to  cause  dropsy,  or  is  the  dropsy  chiefly  due  to  hydraemia  ?  Chiefly 
to  hydremia,  for  we  meet  with  cases  of  extreme  tricuspid  regurgitation, 
with  full  pulsating  jugulars,  much  lividity  and  dyspncea,  and  yet  no 
dropsy,  and  it  is  found  these  patients  pass  a  normal  quantity  of  urine; 
but  when  the  urine  diminishes,  dropsy  sets  in,  and  in  proportion  to  the 
scantiness  of  the  urine.  Still,  no  doubt  venous  congestion  from  tricuspid 
rf.gnrgitation  favors  dropsy  in  other  ways  than  by  causing  hydraemia,  for 
distension  of  the  right  side  of  the  heart,  with  general  venous  obstruction. 


34  DROPSY. 

must  lessen  absorption  by  the  veins  and  lymphatics,  and  in  this  way  cause 
the  parenchymatous  fluid  to  accumulate. 

Kemedics  may  remove  dropsy: — (i.)  By  diminishing  lateral  pressure 
on  the  walls  of  the  blood-vessels,  and  so  lessening  transfusion  from  the 
blood-vessels,  (ii.)  Increasing  absorption,  (iii.)  Both  ways  combined, 
(iv.)  By  increasing  the  lateral  pressure  in  the  blood-vessels  of  the  glo- 
meruli and  so  increasing  the  quantity  of  urine,  (v.)  By  removing 
those  diseased  conditions  of  the  kidneys  which  hinder  their  secretion. 

Digitalis  affords  a  good  example  of  a  remedy  acting  through  several 
of  the  foregoing  methods.  By  its  action  on  the  diseased  heart  it  obvi- 
ates the  effect  of  mitral  disease;  hence  more  blood  is  sent  into  the  aorta. 
Arterial  pressure  is  thus  raised  in  all  the  organs,  and  amongst  other 
parts  in  the  glomeruli  of  the  kidneys,  and  hence  more  urine  is  secreted, 
the  blood  is  purged  of  its  excess  of  water,  and  the  dropsy  is  thus  absorbed 
into  the  circulation,  and  quickly  eliminated  through  the  kidneys.  But 
it  also  acts  in  other  ways.  By  obviating  tricuspid  regurgitation,  through 
its  influence  on  the  left  side  of  the  heart,  digitalis  lessens  or  removes 
passive  congestion,  diminishes  blood-pressure,  and  consequently  filtration, 
reduces  the  amount  of  transfusion  from  the  blood-vessel,  and  j^revents 
further  development  of  the  dropsy.  By  obviating  venous  obstruction,  it 
removes  lymphatic  obstruction,  and  thus  favors  absor2)tion  by  the  lym- 
j)h:itics;  hence  the  excess  of  liarenchymatous  fluids  is  taken  up  by  these 
vessels.  Moreover,  if  there  is  much  dropsy,  on  removing  the  congestion, 
the  pressure  of  the  fluids  outside  the  blood-vessels  very  probably  be- 
comes greater  than  the  pressure  in  the  vessels,  and  hence  the  fluids  will 
flow  into  the  blood-vessels.  The  water  in  the  tissues  is  then  brought 
back  into  the  circulation,  and  eliminated  by  the  kidneys.  But  digitalis 
also  by  its  indirect  influence  acts  on  the  kidneys.  During  tricuspid  re- 
gurgitation the  kidneys  become  congested,  hampered,  and  inactive.  Ee- 
moving  general  congestion  by  its  effects  on  the  heart,  digitalis  relieves 
the  kidneys,  and  allows  them  to  return  to  their  natural  state,  and  hence 
they  quickly  eliminate  the  excess  of  water  in  the  blood,  due  to  the  ab- 
sorption of  the  drojjsical  fluid.  When  all  the  water  has  been  absorbed 
from  the  tissues  into  the  blood,  and  eliminated  by  the  kidneys,  digitalis 
no  longer  causes  an  excessive  flow  of  urine,  as  would  happen  if  it  acted 
directly  on  the  kidneys. 

It  may  be  urged  that  we  have  regarded  the  dropsy  of  tricuspid  regur- 
gitation as  in  part  due  to  heightened  vascular  tension  through  the  great 
venous  congestion,  and  that  if  digitalis  increases  arterial  tension  it  should 
increase  rather  than  diminish  the  dropsy;  but  it  must  be  borne  in  mind 
that  digitalis  removes  the  tricuspid  regurgitation  and  venous  congestion 
by  the  same  means  that  it  causes  more  blood  to  be  sent  into  the  arterial 
system,  and  so  heightens  arterial  tension. 

There  is  another  form  of  dropsy  needing  descrijition,  that  due  to 
anaemia.  After  severe  loss  of  blood,  or  exhausting  drains  of  albuminous 
fluid,  as  in  diarrhoea  or  chronic  dysentery,  a  patient  often  becomes  very 
dropsical.  A  small  amount  of  dropsy  at  the  ankles  also  is  common  in 
other  forms  of  ana?mia,  as  in  chlorosis.  How  is  this  dropsy  produced  ?  It 
cannot  be  explained  satisfactorily  by  ascribing  it  to  hydraemia ;  for  though 
the  Avater  is  relatively  increased  to  the  amount  of  albumen  and  corpuscles, 
the  total  volume  of  the  blood  is  diminished  by  hemorrhage,  and  there 
cannot,  therefore,  occur  increased  lateral  pressure  from  increased  volume 
of  the  blood,  as  occurs  when  water  is  retained  in  the  system  from  dimin- 


EFFECTS    OF    COLD    ON"    THE    BODY.  35 

ished  excretion  from  the  kidneys;  an  increased  pressure  leading  to  in- 
creased transfusion  through  the  capillaries  into  the  parenchyma. 

If  not  due,  then,  to  an  absolute  excess  of  water  increasing  the  total 
amount  of  blood,  how  is  the  dropsy  explained  ?  Is  it  due  to  the  deficiency 
of  red  corpuscles  or  of  albumen  ?  It  is  not  due  to  deficiency  of  the  red 
corpuscles;  for  in  chlorosis,  where  the  red  corpuscles  are  greatly  dimin- 
ished while  the  amount  of  albumen  remains  much  the  same,  very  little 
or  no  dropsy  occurs,  and  it  is  in  those  cases  only  when  the  blood  is  greatly 
drained  of  albumen  that  extensive  dropsy  ensues. 

From  Cohnheim's  experiments  it  is  assumed  that  in  anaemia  the  vessels 
undergo  change  and  permit  fluid  more  easily  to  transude  through  the 
vessels. 


THE  EFFECTS   OF    COLD    ON   THE   BODY. 

Before  treating  separately  of  the  various  kinds  of  cold  baths,  I  think 
it  will  save  repetition,  and  j)rove  otherwise  useful,  to  make  some  j^re- 
iiminary  remarks  on  the  efl'ects  of  cold  on  the  human  body.  These 
effects  are  various,  according  to  the  way  cold  is  employed.  Cold  is  a 
refrigerator,  an  aneesthetic,  a  tonic,  an  excitant,  or  a  depressant.  Cold 
applied  to  the  surface  of  the  body,  either  as  the  douche  or  cold  bath, 
affects  the  system  through  its  influence  on  the  nerves,  reflected  on  the 
skin,  or  to  distant  parts,  and  by  abstracting  heat. 

The  application  of  cold  withdraws  heat  from  the  body,  and  cools  both 
the  sujDcrficial  and  deep  parts.  The  general  cold  bath  will  produce  a 
very  considerable  reduction  of,  the  heat  of  the  surface  to  the  extent  even 
of  10°  Fall,  in  the  trunk,  and  even  considerably  lower  in  the  extremities. 
The  general  cold  bath  might  be  supposed  capable  of  reducing  the  heat 
of  the  body's  surface  for  a  considerable  time;  this,  however,  is  not  the 
case,  for  the  skin  of  the  trunk  speedily  becomes  warm  again,  although 
for  some  hours  afterward  the  extremities  may  remain  cold,  and  the  tem- 
perature in  the  axilla  almost  recovers  itself  in  a  few  minutes,  although 
the  bather  may  have  been  immersed  half  an  hour,  or  longer,  in  water  at 
a  temperature  of  60°. 

Of  course,  it  is  not  here  maintained  that  heat  is  not  abstracted  from 
the  body;  but,  as  will  be  shown  in  another  place,  the  loss  is  so  raj^idly 
restored  that  the  cold  bath  will  not  depress  the  skin's  temperature  in  a 
healthy  person  for  any  notable  time. 

Cold  sponging,  so  often  employed  in  fevers  with  such  evident  relief, 
exerts  a  very  slight  and  transient  influence  on  the  heat  of  the  body,  as 
may  be  ascertained  by  aid  of  the  thermometer;  hence  the  sense  of  com- 
fort derived  from  the  sponging  cannot  be  ascribed  wholly,  or  hardly  in 
part,  to  its  refrigerating  influence.  This  relief  may  be  due  to  the  re- 
moval of  impurities  which  perhaps  irritate  the  skin,  or  annoy  by  their 
odor,  and  by  mitigating  the  parched  condition  of  the  surface;  for  a  skin 
hotli  hot  and  dry  is  a  source  of  much  greater  discomfort  than  a  moist 
though  even  hotter  skin.  Sponging  with  tepid  water,  so  as  to  restore 
moisture  to  the  parched  skin,  gives  marked  comfort  to  the  patient. 

The  foregoing  remarks  apply  only  to  the  surface  of  the  body;  but 
the  general  cold  bath  will  likewise  reduce  the  temjierature  of  the  inter- 
nal organs.     This  reduction,  never  very  great,  is  restored  to  the  deep 


36  EFFECTS  OF  COLD  ON  THE  BODY. 

even  more  quickly  than  to  the  superficial  parts;  so  that,  as  might  be 
inferred,  the  general  cold  bath  is  still  less  efficient  as  a  refrigerator  of 
the  internal  than  of  the  superficial  organs.  In  fever-free  persons,  there- 
fore, the  general  cold  bath  must  rank  very  low  as  a  refrigerator. 

It  is,  however,  otherwise  with  the  body  of  a  jiatient  whose  tempera- 
ture is  unnaturally  raised  with  fever.  The  immersion  of  fever-stricken 
patients  in  the  cold  bath,  or  packing  them  with  the  cold  sheet,  will 
jiroduce  a  considerable  and  durable  lowering  of  the  temperature. 
Whether  this  reduction  is  eifected  by  abstraction  of  heat,  or  by  prevent- 
ing its  unnatural  formation,  it  is  impossible  at  present  to  decide. 

The  application  of  cold,  partly  by  its  topical  action,  but  chiefly 
through  the  vaso-motor  system,  first  contracts  the  blood-vessels  of  the 
skin,  which  on  discontinuing  the  cold  dilate,  and  the  surface  becomes 
redder,  warmer,  and  glowing.  Moreover  the  vessels  of  distant  and  in- 
ternal parts  are  similarly  affected,  as  experiments  have  shown  in  the 
case  of  the  mesentery  and  the  membranes  of  the  brain  (Schiiller,  Frank). 
Winternitz  maintains  that  he  has  experimentally  proved  that  it  is  jios- 
sible  to  control  the  effect  of  cold  and  direct  and  localize  its  influence ;  he 
finds  that  cold  applied  to  the  foot  affects  chiefly  the  inter-cranial  circu- 
lation ;  cold  to  the  thigh,  the  pulmonary  circulation ;  and  cold  to  the 
back,  the  circulation  of  the  pituitary  region. 

The  moderate  and  brief  application  of  cold  not  only  heightens  arterial 
tension,  but  likewise  increases  the  frequency  of  the  heart's  action,  and  if 
this  practice  is  continued  daily,  it  increases  the  corpuscular  richness  of 
the  blood,  and  the  haemoglobin  of  the  corpuscles,  and  it  removes  anemia. 

Cold,  when  judiciously  employed,  is  well  known  to  be  a  powerful 
tonic.  A  cold  climate  and  cold  bathing  are  tonic  and  bracing.  The 
theory  of  the  tonic  action  of  cold  may  perhaps  be  stated  thus : — During 
exposure  to  cold,  the  body's  loss  of  heat,  as  tested  by  the  thermometer, 
is  by  no  means  a  measure  of  the  quantity  withdrawn.  Many  observers 
have  shown  that  at  such  times  increased  combustion  occurs,  whereby 
much  of  the  lost  heat  is  compensated,  and  the  temperature  is  maintained 
or  soon  restored.  This  increased  oxydation  of  the  tissues  is  demon- 
strated by  the  greatly  increased  quantity  of  carbonic  acid  thrown  off  by 
the  lungs  on  exposure  to  cold.  Now  the  most  vigorous  health  is  main- 
tained by  a  rapid  construction  and  destruction  of  tissues,  within  certain 
bounds,  provided  these  two  processes  are  fairly  balanced.  On  exposure 
to  cold,  the  lungs  absorb  more  oxygen,  the  tissues  are  more  rapidly  and 
freely  oxydized,  and  thus  the  processes  of  destruction  and  reparation  go 
on  in  larger  measure.     How  is  this  eff'ected  ? 

In  the  process  of  nutrition,  apart  from  the  nerves,  we  have  three 
factors,  the  nutritive  plasma,  the  tissues,  and  oxygen.  When  food  is 
taken,  digested,  and  introduced  into  the  blood,  both  formation  and  de- 
struction of  the  nitrogenous  tissues  begin,  formation  being  limited  by 
destruction;  and  Avhen  the  destruction  of  tissues  ceases,  the  further  as- 
similation of  the  nutritive  materials  of  the  blood  comes  likewise  to  an 
end.  These  destructive  changes  take  place  in  proportion  to  the  amount 
of  oxygen  absorbed^  and  when  this  gas  is  exhausted,  many  products  of 
destruction  remain  only  partially  oxydized.  further  tissue  disintegration 
ceases,  and  assimilation  is  suspended.     (Parkes.) 

Under  exposure  to  cold,  oxygen  being  abundantly  absorbed,  the  effete 
products  in  the  blood  are  first  consumed,  thus  purifying  the  blood,  and 
rendering  it  fit  to  nourish  the  body;  next,  by  its  consuming  action  on  the 


;bffects  of  cold  ois"  the  body.  37 

tissues,  oxygen  promotes  tlio  cycle  of  changes  just  described,  food  is  taken 
and  assimilated,  and  the  destruction  and  construction  of  the  tissues  rapidly 
go  on,  so  creating  great  physical  Angor.  Thus  it  is  that  cold  climates  are 
invigorating. 

Applied  locally,  cold  may  act  as  a  tonic  (see  Douche) ;  but  if  too  long 
continued,  or  excessive,  it  depresses;  for,  by  contracting  the  vessels  too 
sharply  or  too  continuously,  it  lessens  the  supply  of  Ijlood  to  the  tissues, 
and  thereby  diminishes  their  cell-growth  and  tissue  change.  Ijitense 
cold,  applied  for  some  minutes,  will  abolish  sensation,  and  in  this  way  be- 
comes an  anaesthetic;  and,  if  the  cold  is  too  long  contiiuied,  the  part  will 
die  and  become  gangrenous. 

The  sudden  partial  application  of  .cold  may  act  reflexly  as  an  excitant. 
A  cold  hand  applied  to  the  abdomen  excites  contractions  in  the  parturient 
womb.  Cold  water  smartly  sprinkled  on  the  face  of  a  swooning  person  is  a 
familiar  way  of  restoring  consciousness.  The  same  treatment  will  help  to 
establish  breathhig  in  weak  or  apparently  still-born  children,  or  to  recover 
persons  over-dosed  with  chloroform,  or  narcotized  with  opium  or  tipple. 

The  local  application  of  cold  may  affect  deep-seated  vessels  reflexly. 
Kossboch  finds  in  his  experiments  on  animals  that  the  application  of  an 
ice-bag  to  the  skin,  as  on  the  abdomen,  affects  the  vessels  of  the  trachea, 
the  mucous  membrane  becoming  first  pale,  followed  soon  after  by  slight 
redness,  passing  later  into  a  blue-red  tint,  when  a  copious  watery  secre- 
tion ensues.  Here,  then,  we  have  an  instance  of  the  induction  of  venous 
congestion  by  the  local  application  of  cold,  and,  as  Brunton  remarks, 
these  experiments  explain  '*  how  readily  a  draught  of  cold  air  on  some 
]3art  of  the  body  may  cause  inflammation  of  the  respiratory  organs." 

Experiments  on  cold-blooded  animals  show  how  greatly  temperature 
modifies  the  action  of  drugs  on  voluntary  and  cardiac  muscle,  on  motor 
and  secretory  nerves,  on  the  spinal  cord,  and  probably  on  all  tissues.  As 
a  rule  poisons  act  more  energetically  on  frogs  in  hot  than  in  cold  weather, 
a  dose  sufficient  to  produce  great  effect  in  hot  weather  being  inoperative 
in  cold.  Brunton  finds  that  great  heat  or  great  cold  prevent  the  action 
of  veratria  on  voluntary  m-uscle;  and  I  find  heat  greatly  increases  the 
susceptibility  of  the  heart  and  muscle  to  veratria  and  modifies  its  action. 

Lucdisinger  shows  that  temperature  influences  the  motor  nerves,  for 
he  finds  that  extremes  of  temperature  abolish  the  action  of  guanidine  on 
the  motor  nerves. 

Temperature  also  modifies  secretion,  probably  by  its  influence  on  the 
secretory  nerves,  for  pilocarpine  acts  less  on  animals  whose  temperature 
is  reduced  by  placing  them  in  a  cold  chamber  (Brunton);  and  it  is  well 
known  that  this  drug  acts  much  more  powerfully  when  the  patient  is  in 
a  warm  bed  or  before  a  fire  than  if  his  skin  is  exposed  to  cold. 

Some  poisons,  like  chloral,  alcohol,  etc.,  act  in  part  by  reducing  the 
temperature  of  the  body;  by  lessening  combustion,  and  by  disturbing  the 
mechanism  regulating  the  production  and  loss  of  heat,  so  that  the  temper- 
ature is  more  quickly  raised  or  cooled  by  heat  or  cold  (Brunton).  In  such 
cases,  by  maintaining  a  proper  temperature  of  the  body,  may  avert  death. 


38  COLD    BATH. 


THE   COLD   BATH,   INCLUDING   SEA-BATHING. 

Cold  water  may  be  applied  for  the  sake  of  its  moisture,  its  tempera- 
ture, or  both  coujoined.  If  we  require  merely  moisture,  and  temperature 
is  of  no  consequence,  tepid  or  warm  water  is  both  preferable  and  more 
agreeable.  Cold  water  is  generally  employed  to  abstract  heat  from  either 
the  whole  surface  of  the  body,  or  from  some  particular  ])art  of  it,  or  to 
induce  general  or  local  excitement  and  shock. 

Since  the  skin  absorbs  neither  the  water  of  the  bath,  whether  it  be 
warm  or  cold,  nor  any  substances,  soluble  or  insoluble,  which  may  be 
added  to  the  water,  it  follows  that  whatever  may  be  the  effect  of  baths  it 
must  be  explained  by  their  direct  action  on  the  skin. 

In  speaking  of  the  general  cold  bath,  we  shall  speak  mainly  of  cold  sea- 
bathing, this  being  a  far  more  powerful  medicinal  agent  than  the  simple 
cold  bath,  although,  indeed,  their  action  is  identical,  the  difference  in 
their  effects  being  one  merely  of  degree:  and,  as  we  proceed,  we  shall 
point  out  how  these  differences  affect  the  body. 

On  entering  a  cold  sea-bath,  there  is  at  first  a  sensation  of  depression, 
great  or  little,  according  to  the  coldness  of  the  water.  The  skin  becomes 
pale  and  shrivelled,  and  presents  the  familiar  appearance  "goose-skin,"  a 
condition  produced  by  the  contraction  of  the  skin,  and  the  consequent 
protrusion  of  the  hair-roots  and  follicles.  There  is  a  general  shivering, 
some  blueness  of  the  lips,  nose,  and  extremities,  considerable  reduction  of 
the  temperature  of  the  skin,  quickened  pulse,  convulsive  and  sobbing 
breathing  as  the  water  rises  to  the  chest,  especially  when  the  bath  is  en- 
tered slowly.  The  system  soon  becoming  roused  to  meet  and  to  resist  the 
depressing  effects  of  cold,  in  a  few  seconds  a  sensation  of  general  exhilara- 
tion ensues.  The  skin  becomes  ruddy  and  glowing;  tiie  breathing  full 
and  easy;  the  pulse  rather  quick  and  strong;  the  spirits  exalted,  and  the 
bather  feels  increased  vigor,  both  of  mind  and  body.  If  he  quits  the  bath 
now,  or  before  the  period  of  exhilaration  ceases,  the  buoyant  condition 
endures  more  or  less  for  the  rest  of  the  day,  showing  that  the  bath  thus 
acts  as  a  tonic  to  the  system. 

On  the  other  hand,  if  the  bath  is  prolonged,  depression  again  comes 
on.  The  bather  feels  cold,  shivers,  becomes  blue  and  numb  in  the  more 
exposed  and  smaller  parts,  whence,  on  account  of  their  size,  warmth  is 
more  readily  withdrawn,  and  he  is  seized  with  a  sensation  of  depression 
and  wretchedness.  Baths  prolonged  to  this  injudicious  extent  often  pro- 
duce damaging  results,  which  may  continue  for  hours,  and  even  days, 
sometimes,  indeed,  inflicting  serious  injury  on  the  health,  especially  in  a 
weak  or  growing  person.  For  many  hours  after  the  bath  he  complains  of 
general  languor,  with  a  repugnance  to  exercise,  whether  of  body  or  mind; 
his  temper  is  fretful  and  morose,  the  circulation  feeble  and  languid,  with 
sinking  at  the  epigastrium,  loss  of  appetite,  chilliness  of  the  surface,  and 
cold  extremities.  It  need  scarcely  be  said  that  consequences  like  these  are 
to  be  carefully  avoided:  yet  rliese  risks  will  often  be  encountered,  unless 
the  doctor  gives  specific  and  minute  directions,  so  great  is  the  prevailing 
ignorance  and  error  on  the  subject  of  bathing. 

If  the  exposure  in  the  cold  bath  is  continued  beyond  this  point,  or  if 
the  cold  is  severe,  its  effects  become  more  manifest;  great  depression  and 
a  sensation  of  utter  misery  set  in,  followed  shortly  by  heaviness  and  drow- 
siness, Avliich  deepen  sometimes  into  coma,  till  a  kinel  of  apoplectic  state  is 


COLD    BATH. 


39 


readied,  then  asphyxia  and  death  from  paralysis  of  the  muscles  of  respi- 
ration. 

Baths,  then,  on  the  one  hand,  judiciously  employed,  are  very  powerful 
tonics,  while  on  the  other,  if  unwisely  used,  they  induce  great  depression 
of  the  bodily  powers  and  produce  serious  mischief.  The  superiority  of 
sea-baths  has  been  placed  beyond  mere  surmise;  for  direct  experiment  has 
established  the  fact  that  a  sea-bath  acts  far  more  powerfully  on  tissue 
metamorphosis  than  the  simple  water-bath.  While  the  sea-bath  increases 
the  process  both  of  destruction  and  of  construction  of  tissue,  yet  that  of 
construction  is  in  excess  of  that  of  destruction,  with  the  effect  of  inducing 
not  only  increased  vigor  of  the  functions  of  the  body  but  an  actual  aug- 
mentation of  its  weight.  Sea-air,  it  is  true,  acts  in  the  same  way,  so  that 
it  is  difficult  to  determine  to  what  extent  improved  health  results  from 
sea  climate  or  sea- baths. 

The  cold  bath  is  almost  universally  employed  for  its  tonic  virtue.  To 
obtain  this  wished-for  result,  the  bath  should  be  discontinued  at  the  time 
it  causes  general  exhilai'ation,  for  the  system  then  appears  to  be  roused 
into  action  to  resist  the  depressing  influence  of  cold,  and  if  at  this  point 
the  bath  is  discontinued  tlie  general  healthful  stimulation  persists;  for, 
whilst  taking  the  bath,  and  probably  for  some  time  afterwards,  oxidation 
of  the  tissues  is  increased,  the  blood  is  purified  of  effete  products,  and  the 
process  of  construction  and  destruction  of  tissue,  on  which  vigor  of  both 
mind  and  body  depends,  are  intensified. 

Bathing  therefore  increases  appetite,  improves  digestion  and  the  assimi- 
lation of  food.     The  bath,  then,  is  a  tonic  in  the  strictest  sense  of  the  word. 

Used  in  accordance  with  the  rules  to  be  immediately  laid  down  the 
good  effect  of  the  bath  soon  becomes  apparent,  and  the  patient  gains  in 
weight,  his  complexion  becomes  ruddy  and  clearer,  his  muscles,  especially 
if  he  conjoins  exercise  with  the  baths,  acquire  firmness  and  strength,  the 
mental  debility  arising  from  deficient  nutrition  of  the  nervous  system 
speedily  passes  away,  and  he  soon  recovers  mental  and  bodily  vigor. 

The  important  question  arises — IIow  can  we  best  obtain  these  invigor- 
ating effects  ? 

Our  object  clearly  is  to  secure  the  greatest  possible  amount  of  stimula- 
tion, and  to  ensure  as  long  as  possible  the  persistence  of  the  increased  vigor 
of  nutrition.  To  obtain  the  greatest  degree  of  stimulation  we  must  duly 
apportion  the  temperature  and  duration  of  the  bath  to  the  patient's 
strength;  and  to  ensure  the  continuance  of  nutritive  vigor  as  long  as  pos- 
sible the  patient  should  leave  the  bath  at  the  climax  of  general  exhilara- 
tion and  stimulation,  avoiding  carefully  the  onset  of  the  next  stage,  that 
of  depression. 

The  bather,  if  very  weak,  manifests  but  little  functional  energy  to  resist 
the  depression  from  the  cold.  Indeed,  if  this  is  intense,  the  stage  of  stim- 
ulation may  not  come  on  at  all,  but,  depressed  from  the  first,  the  patient 
may  so  remain  for  a  long  time.  Injudicious  bathing  often  seriously 
injures,  and  even  endangers  the  lives  of  weakly  persons. 

The  depressing  effects  of  a  cold  bath  are  proportioned  to  its  coldness 
and  duration.  The  colder  the  water,  the  greater  the  depression  it  occa- 
sions— greater,  too,  when  the  water  is  in  motion  than  Avhen  at  rest.  More- 
over, the  longer  the  period  of  immersion  the  greater  is  the  degree  of  de- 
pression. 

When  the  patient  is  weak  and  prostrated  by  illness,  the  bath  must  not 
be  too  cold,  nor  continued  too  long,  and  the  water  should  be  at  rest. 


40 


COLD    EATir. 


Thus,  wo  must  have  regard  to  the  strength  of  the  patient,  tlie  temperature 
of  the  water,  and  the  duration  of  the  bath.    • 

Here  it  will  be  convenient  to  consider  in  what  respect  sea- baths  differ 
from  simple  water-baths,  and  to  explain  the  tonic  superiority  of  sea-baths. 

1st.   In  sea-water  various  ingredients  are  held  in  solution. 

2d.  The  variations  in  temperature  of  sea- water,  in  the  varying  seasons 
of  the  year,  are  much  less  than  those  of  river-water. 

3d.  While  the  sea  is  always  more  or  less  in  motion,  river- water  is  com- 
paratively at  rest. 

The  salts  in  solution  are  supposed  to  act  as  invigorating  stimulants  to 
the  skin,  so  that  a  patient  unable  to  bathe  in  simple  water  without  suffer- 
ing great  depression  can  bathe  in  sea-water  with  great  benefit.  Moreover, 
as  the  sea's  temperature  never  falls  very  low  in  winter,  sea-bathing  may 
often  be  continued  late  in  the  autumn,  or  even  into  the  early  winter  months. 

The  motion  of  the  waves  increases  the  depressing  effects  of  the  bath, 
but  if  the  bather  is  strong  enough,  it  also  increases  the  ensuing  reaction; 
and  thus  the  commotion  of  the  waves,  while  more  bracing  to  the  strong, 
is  at  the  same  time  highly  exhilarating. 

These  guiding  principles  borne  in  mind,  we  shall  be  able  under  all  cir- 
cumstances to  give  correct  answers  to  the  various  questions  paticmts  may 
put  to  us  concerning  bathing.  One  most  frequently  asked  is — How  long 
shall  the  bath  be  continued  ? 

Our  answer  must  be  regulated  by  the  strength  of  the  patient  and  the 
coldness  of  the  water.  If  the  water  is  cold,  or  the  patient  is  very  weak, 
we  must  at  first  forbid  out-door  sea-bathing  and  substitute  a  tepid  bath, 
the  temperature  of  which  should  be  slowly  reduced  until  that  of  the  sea 
is  reached.  Then,  if  the  day  is  fine  and  the  sea  calm,  the  bath  may  be 
taken  in  the  open  air.  Though  it  may  be  considered  safe  to  let  the 
patient  bathe  in  the  sea,  yet  if  he  is  very  weak  and  unaccustomed  to  bath- 
ing, his  stay  there  must  be  very  brief;  it  Avill  often  suffice  to  allow  tAVO  or 
three  waves  to  pass  completely  over  him,  when  he  should  at  once  come 
ashore  and  wipe  himself  thoroughly  dry,  using  plenty  of  friction  to  the 
skin,  for  which  purpose  Cash's  towels  are  well  adapted.  With  increasing 
strength,  and  becoming  accustomed  to  the  effects  of  the  water,  he  may 
continue  the  bath  for  a  longer  time,  but  it  is  seldom  advisable  for  a  con- 
valescent to  bathe  longer  than  from  five  to  ten  minutes.  Some  patients, 
nay,  even  some  healthy  persons,  can  bear  a  sea-bath  only  every  other  day. 

Then  as  to  the  time  of  day  best  suited  for  bathing  the  greatest  igno- 
rance prevails,  before  breakfast  being  currently  believed  to  be  the  best 
time;  yet  this  practice  is  not  without  risk  even  for  the  robust,  who  are 
often  made  ailing  and  fatigued  by  it  for  the  rest  of  the  day. 

Our  object  in  using  the  bath,  as  we  have  before  said,  is  to  obtain  pro- 
longed and  energetic  stimulation.  We  must  therefore  choose  that  time 
when  the  body  is  most  refreshed,  invigorated,  and  nourished.  These  con- 
ditions, it  might  be  supposed,  would  co-exist  in  the  early  morning  after 
a  sound  and  refreshing  sleep.  It  must  be  borne  in  mind,  however,  that 
before  breakfast  the  body  has  undergone  a  fast  of  several  hours,  and  is  in 
want  of  food,  without  which  the  bodily  functions  may  very  readily  become 
depressed.  In  fact,  only  a  robust  person  is  able  to  bear  a  sea-bath  before 
breakfast. 

Thus  theory  and  practice  are  both  opposed  to  this  period  for  bathing, 
both  pointing  to  a  time  between  breakfast  and  dinner  as  the  most  appro- 
priate. 


COLD    BATH.  41 

This  leads  us  to  the  consideration  of  another  question;  namely,  after 
a  meal,  how  long  a  time  should  pass  before  a  bath  may  be  taken;  and, 
after  a  bath,  what  time  should  pass  before  taking  food  ?  Now  cold  bath- 
ing produces  a  great  shock  to  the  skin  and  system  generally;  and  any 
powerful  mental  or  bodily  impression  will  check  or  even  arrest  for  a  time 
many  of  the  functions,  even  if  in  active  operation.  This  is  the  case  with 
digestion.  Any  great  excitement,  it  is  well  known,  can  stay  this  process 
more  or  less  completely,  and  the  cold  bath  is  generally  sufficient  entirely 
to  arrest  it;  therefore,  before  the  bath,  an  adequate  time  should  elapse, 
so  as  to  permit  the  almost  complete  digestion  of  the  breakfast,  that  is,  an 
interval  of  about  three  hours.  ISTor,  for  the  reasons  just  pointed  out, 
should  the  bath  be  taken  immediately  before  a  meal;  otherwise,  little  or 
no  gastric  juice  is  secreted,  and  food  lies  half-digested  in  the  stomach. 

And  for  a  reason  somewhat  similar,  the  bather  should  not  go  into  the 
water  whilst  under  the  influence  of  any  great  emotional  excitement.  The 
nervous  force  (on  which  there  appears  to  be  set  a  limit)  being  directed 
strongly  in  one  channel,  the  bath  will  not  produce  nervous  stimulation,  so 
that  the  patient  will  feel  languid,  cold,  shivering,  and  depressed.  Obvi- 
ously, for  the  same  reason,  children  must  be  coaxed,  not  dragged  into 
the  water  against  their  will.  In  early  life  there  is  often  much  terror  of 
bathing;  and  if,  in  spite  of  this,  the  child,  while  screaming  with  fright,  is 
forcibly  dragged  into  the  sea,  very  ill  effects  may  follow;  for,  missing  the 
stage  of  stimulation,  the  child  may  remain,  often  for  days,  depressed 
and  ill. 

Is  there  any  age  rendering  sea-bathing  dangerous,  and  to  be  prohibited  ? 

It  is  generally  accepted  that  young  children, — say  under  two  years  of 
age, — being  very  impressionable,  ought  not  to  undergo  the  shock  of  a  cold 
sea-bath.  At  the  other  extreme  of  life,  when  the  enfeebled  powers  of 
the  body  are  incapable  of  strong  reaction,  sea-bathing  is  inadmissible,  for 
it  is  as  well  known  that  in  old  people  the  heat-forming  force  is  much  re- 
duced. Moreover,  undue  vascular  excitement  ma}'  prove  dangerous;  the 
vessels  in  the  aged,  often  brittle  through  degeneration,  are  in  danger  of 
giving  way,  and  thus  under  any  unusual  strain  causing  apoplexy. 

The  foregoing  remarks  imply  that  fatigue  is  a  condition  strongly  ad- 
verse to  cold  bathing.  Even  if  other  conditions  are  favorable,  it  is  seldom 
advisable  for  weakly  persons  to  take  a  bath  on  the  day  following  their  arri- 
val at  the  sea-side.     They  should  wait  till  all  fatigue  has  passed  away. 

Does  pregnancy  forbid  sea-bathing  ? 

If  a  woman  has  miscarried  or  aborted,  or  if  of  an  excitable  tempera- 
ment, baths  may  be  expected  to  do  harm;  and  in  far  advanced  pregnancy 
a  sea-bath  may  perhaps  produce  abortion.  But  under  other  circumstances, 
and  with  due  regard  to  the  conditions  previously  laid  down,  bathing  will 
benefit  both  mother  and  child.  Nor,  if  accustomed  to  the  practice,  need 
a  woman  discontinue  bathing  at  the  menstrual  period,  although  it  is 
always  inadvisable  to  begin  at  such  a  time,  since  the  shock  may  check  or 
arrest  the  secretion,  and  thus  induce  perhaps  many  months  of  amenorrhoea. 

In  the  choice  of  coast,  and  the  time  of  year,  we  must  have  regard  to 
the  condition  of  the  patient.  If  not  very  weak,  with  the  health  only  a 
little  undermined,  then  a  rugged  coast,  where  the  sea  is  rough  and  bois- 
terous, should  be  recommended.  However,  should  the  health  be  much 
broken,  then  a  smooth  sea  is  preferable,  and,  in  a  cold  climate,  the  sum- 
mer is  the  only  suitable  time. 

Exercise  taken  while  bathing  soon  induces  fatigue  and  even  exhaus- 


42 


COLD    BATH. 


tion;  whereas  weakly  patients  must  be  cautioned  to  Le  moderate  in  this 
respect.  Another  evil  should  be  guarded  against:  on  leaving  the  bath,  a 
patient  invigorated  by  it  is  in  danger  of  taking  too  much  exercise,  fatigu- 
ing himself,  and  so  counteracting  the  bath's  good  effect.  The  amount 
of  exertion  permitted  must  be  strictly  in  accordance  with  the  patient's 
condition,  who,  if  very  weak,  should  take  only  horse  or  carriage  exercise. 

A  course  of  sea-bathing  sometimes  causes  the  hair  to  fall  off  abundant- 
ly, naturally  exciting  much  anxiety,  especially  in  women.  Their  fears, 
however,  may  be  quieted  by  the  assurance  of  a  rapid  new  growth.  Other 
troubles  may  arise.  Bathing  sometimes  induces  constipation,  more  or  less 
obstinate;  but  this  need  not  lead  to  the  discontinuance  of  the  bath.  The 
constipation  should  be  removed  by  exercise,  regulated  diet,  or,  these  fail- 
ing, by  purgatives,  Dyspepsia  and  diarrhoea  also  sometimes  occur  dur- 
ing sea-bathing.  The  bather  should  be  discreet  as  to  the  hour  of  the  bath, 
the  time  spent  therein,  and  if,  notwithstanding  every  care,  dyspepsia  or 
diarrhoea  continues,  the  bath  must  be  temporarily  or  permanently  discon- 
tinued. In  fact,  sea-air  alone  will,  in  some  constitutions,  induce  these 
disorders. 

Eestlessness  at  night  is  sometimes  attributed  to  sea-bathing.  Many 
people,  no  doiibt,  find  that  living  too  near  the  sea-shore  often  produces 
broken  and  sleepless  nights.  On  the  shores  of  the  Mediterranean,  especi- 
ally along  the  Eiviera,  this  is  notably  the  case.  On  removal  inland,  a  mile 
or  thereabouts,  this  restlessness  vanishes:  for  instance,  sleep  unattainable 
at  Cannes  itself  is  secured  at  Cannet,  a  mile  or  so  inland.  Broken  rest 
may  often  be  traced  to  dietetic  irregularities,  or  to  late  hours.  A  late  and 
heavy  meal  will  sometimes  cause  restlessness,  whilst  a  good  night  will  fol- 
low an  early,  light,  and  digestible  repast.  iSome  patients  mar  their  rest 
by  taking  stimulants  shortly  before  bedtime,  while,  on  the  other  hand, 
others  cannot  sleep  without  a  "  nightcap.'" 

A  bather  should  plunge  into  the  waves  at  once,  and  on  no  account  stand 
undresssed  and  hesitating  till  he  becomes  cold  and  shivers.  It  is  a  com- 
mon and  pernicious  error  to  suppose  that  it  is  necessary  to  be  well  cooled 
down  before  plunging  into  the  bath.  If  needful,  a  short,  brisk  walk 
should  be  taken  just  before  the  bath,  to  warm  the  surface  and  extremities. 

The  effect  of  cold  is,  in  proportion  to  its  degree,  to  lessen  the  perspi- 
ration. A  cold  bath  at  first  checks  perspiration,  but  soon  afterward  this 
secretion  becomes  considerably  augmented,  and  in  a  greater  degree  after 
sea  than  after  simple  water-bathing.  Driven  from  the  skin,  the  blood 
floAVS  into  and  fills  the  internal  organs,  and  the  kidneys  partaking  of  this 
congested  state,  probably  explains  the  frequent  and  transitory  occurrence 
of  a  small  quantity  of  albumen  in  the  urine,  during  the  bath. 

The  effects  of  cold  baths  on  tissue  change  have  already  been  pointed 
out,  and  the  observations  on  this  subject  will  be  supplemented  and  con- 
firmed in  those  we  have  now  to  make  relating  to  the  influence  of  sea-baths  on 
the  constituents  of  the  urine.  Baths  augment  the  quantity  of  urea  or  sul- 
phuric acid  of  the  urine.  Whether  this  increase  exceeds  the  limits  of  the 
natural  healthy  variations,  and  whether  the  experiments  are  sufficiently  nu- 
merous to  prove  it,  has  been  called  in  question.  It  is  not  to  lie  expected  that 
the  tissue  change  would  at  once  be  greatly  augmented,  nor  that  the  increase 
at  any  time  would  exceed  the  maximum  amount  of  health;  consequently 
the  increase  of  urea  in  its  turn  would  not  exceed  the  maximum  quantity 
excreted  in  health,  lint  surely,  if  for  some  time  the  excretion  of  urea  is 
maintained  at  its  maximum,  this  single  fact  would  alone  establish  the  in- 


THE  SITZ-BATH.  43 

fluence  of  baths,  so  far  as  they  coukl  be  expected  to  operate,  and  would 
show  that  sea-bathing  increases  disintegration  of  the  nitrogenous  tissues. 

Beneke's  observations  lead  to  the  same  conclusion.  AVhen  food  was 
taken,  just  sufficient  to  maintain  the  weight  of  the  body  at  a  fixed 
point,  he  found  that  baths  immediately  reduced  the  weight  of  the  body, 
a  loss  certainly  due  to  heightened  disintegration  of  the  tissues.  But 
this  increased  consumption  of  the  tissues  being  accompanied  by  increased 
appetite,  and  by  increased  assimilation,  more  food  is  taken,  and  his  body 
gained  in  weight.  Baths,  it  was  said,  increase  the  quantity  of  uric  acid, 
although  this  is  lessened  by  sea-air;  but  on  this  point  observations  are  as 
yet  insufficient. 

The  urinary  water  is  temporarily  and  often  greatly  increased,  though 
the  whole  day's  urine  is  lessened  in  quantity,  probably  owing  to  the  sub- 
sequent excessive  elimination  by  the  skin.  In  Beneke's  observation  the 
intestinal  secretions  were  also  large,  so  some  water  may  have  escaped  in 
this  way. 

It  is  scarcely  necessary  to  occupy  much  space  with  a  narration  of  the 
cases  likely  to  derive  benefit  from  sed-bathing.  In  chronic  illness  at- 
tended by  debility  sea-bathing  yields  the  best  results;  but  it  is  especially 
useful  to  those  recovering  from  acute  diseases,  and  to  persons  whose 
health  has  been  broken  by  over-work,  by  residence  in  towns,  by  sedentary 
employment,  or  by  injurious  excesses.  It  is  a  question  of  much  impor- 
tance whether  phthisical  j^ersons  should  take  sea-baths,  and  our  answer 
must  be  qualified  by  the  circumstances  of  the  case.  When  the  disease 
is  chronic,  with  little  or  no  elevation  of  temiperature  (little  or  no  fever), 
when,  indeed,  the  case  is  one  of  fibroid  degeneration  of  the  lungs,  with- 
out active  formation  of  tubercle,  sea-baths  may  be  permitted,  due  regard 
being  paid  to  the  rules  just  laid  down. 

When  the  cold  bath  or  cold  sponging  cannot  be  borne,  it  is  often 
useful  vigorously  to  rub  the  body  with  a  towel  wrung  out  in  tepid  or 
cold  water,  or  the  naked  patient  may  have  a  sheet  wrung  out  with  cold 
Avater  thrown  over  his  shoulders,  and  be  rubbed  down  with  the  sheet. 
This  plan  is  useful  to  prepare  the  way  for  the  cold  sponge-bath,  and  is 
applicable  to  the  same  class  of  cases,  since  it  excites  reaction  and  pro- 
duces tissue  change  and  stimulates  digestion ;  like  the  sea-bath,  it  is  a 
true  tonic.     It  is  useful,  too,  to  relieve  fatigue  after  a  hard  day's  walk,  etc. 


THE    SITZ-BATH. 


The  sitz-bath  is  largely  and  beneficially  used  in  hydropathic  institu- 
tions. The  Avater  should  be  between  60°  and  80°,  and  the  patient  should 
sit  in  it  from  five  to  thirty  minutes,  once  or  twice  a  day.  At  first  it 
causes  contraction  of  the  arterioles,  not  only  of  the  immersed  skin,  but 
also  of  the  intestinal  vessels;  hence  more  blood  is  sent  to  the  head  and 
upper  extremities.  After  the  bath  is  discontinued  the  reverse  process 
sets  in,  more  blood  being  sent  to  the  abdominal  organs,  diminished  sup- 
ply flowing  to  the  brain.  The  sitz-bath  greatly  relieves  fatigue  and 
soothes  an  irritable  restless  state  of  the  nervous  system.  It  often  les- 
sens headache,  and  regulates  the  bowels;  it  often  augments  the  catame- 
nial  flow  by  lessening  the  amount  of  blood  in  the  brain,  and  is  in  many 
instances  usefully  employed  to  procure  sleep.  After  the  sitz-bath  reac- 
tion should  be  promoted  by  friction  or  exercise. 


44  ON  PACKING  WITH  THE  WET  SHEET. 


ON  PACKING  WITH  THE  WET  SHEET. 

Packixg  Avitli  the  cold  wet  sheet,  although  at  present  seldom  employed 
outside  hydropathic  establishments,  is  undoubtedly,  in  many  diseases,  a 
very  efficacious  treatment. 

Dr.  Johnson,  in  his  work  on  hydropathy,  directs  the  patient  to  be 
placed  on  a  mattress  Avith  a  pillow  to  support  his  head;  then,  "  upon  the 
mattress,  and  extending  over  the  pillow,  two  blankets  are  spread,  and  over 
this  a  sheet  wrung  out  as  dry  as  possible  with  cold  water.  The  patient 
lies  down  on  his  back,  perfectly  unclotlied,  with  his  head  comfortably 
placed  on  the  pillow;  an  attendant  now  approaches,  say  on  the  patient's 
left,  and  first  puckering  the  blanket  from  the  back  of  the  head  down  to 
the  back  of  the  neck,  reaches  across  his  chest,  seizes  the  right  upper  cor- 
ners of  the  blanket,  and  brings  them  tightly  across  under  the  chin  to  his 
own  side  (the  left),  and  tucks  them  well  and  evenly  under  the  left  shoulder, 
where  it  joins  the  root  of  the  neck,  and  under  the  point  of  the  same 
shoulder.  He  now  reaches  across  the  body  again,  and  brings  over  all  the 
rest  of  the  right  sides  of  the  blankets  to  the  left  side  of  the  patient,  and 
then  proceeds  to  tuck  them  well  and  evenly  under  the  left  side,  beginning 
where  he  left  off,  at  the  point  of  flie  shoulder,  and  proceeding  quite  down 
to  the  heels.  The  patient  is  now  entirely  enveloped  in  one  half  of  the 
blankets,  and  the  attendant  finishes  the  operation  by  passing  over  to  the 
right  side  of  the  patient,  and  then  proceeding  to  tuck  the  left  sides  of  the 
blanket  under  the  right  side  precisely  in  the  same  manner  as  we  have  seen 
him  tuck  the  right  sides  of  the  blanket  under  the  left  side  of  the  patient. 
The  attendant,  standing  on  the  right  side  of  the  patient's  leg,  finally  insin- 
uates his  left  hand  under  the  backs  of  the  ankles,  lifts  them  up,  and  then 
"with  his  right  hand  turns  back  the  lower  ends  of  the  blankets  under  t^e 
heels."  The  wet  sheet  should  reach  to  the  ankles,  and  "  be  wide  enough 
to  overlap  in  front  of  the  body  about  eight  or  twelve  inches;  over  the 
whole  four  or  five  blankets  placed,  and  pressed  down  close  to  the  sides." 

This  pack  is  useful  in  specific  fevers  and  acute  inflammatory  diseases. 
It  has  long  been  employed  in  scarlet  fever,  and  should  be  used  from  the 
beginning  and  throughout  its  course.  In  moderate  attacks  it  is  sufficient 
to  pack  the  patient  from  thirty  to  fifty  minutes;  but  if  the  fever  is  very 
high,  if  the  rash  comes  out  slowly,  imperfectly,  and  of  a  dull  color,  if  the 
l^atient  is  restless  and  wandering,  the  packing  must  be  continued  an  hour 
or  longer,  and  be  repeated  three  or  four  times  a  day.  This  treatment 
develops  the  rash,  greatly  reduces  the  fever,  quiets  the  pulse,  renders  the 
skin  moist  and  comfortable,  and  abates  the  restlessness  and  wandering.  A 
short  time  after  the  application  of  the  wet  sheet  a  patient,  previously 
restless  and  wandering,  commonly  falls  into  a  quiet  refreshing  sleep,  and 
awakes  calm  and  free  from  delirium.  Its  influence  on  the  pulse  and  tem- 
perature is  striking;  the  pulse  in  a  few  hours  falling  fifteen  to  twenty 
beats  in  the  minute;  a  repetition  of  the  packing  greatly  reduces  the  fever. 
The  packing  is  especially  indicated  on  suppression  or  recession  of  the  rash, 
when  serious  symjitoms  are  apt  to  arise;  the  cold  sheet  will  then  bring 
out  a  brilliant  rash,  followed,  generally,  by  immediate  improvement  in 
the  patient's  condition.  It  has  been  recommended  to  dash  two  or  three 
pailfuls  of  cold  water  over  the  patient  after  each  packing.  During  the 
whole  course  of  the  fever  a  cold  wet  compress,  renewed  every  three  hours. 


COLD    BATHS    IN    FEVERS.  45 

slionld  be  worn  round  the  throat;  and  if,  on  the  decline  of  the  fever,  the 
tonsils  remain  large,  or  there  is  chronic  inflammation  of  the  fauces  or 
larynx,  this  ajiplication,  renewed  less  frequently,  or  applied  only  at  night, 
should  be  continued  till  these  morbid  conditions  cease.  The  compress 
should  be  composed  of  linen  several  times  folded,  and  fastened  round  the 
throat  by  another  piece  of  folded  dry  linen.  Cold  packing  is  beneficially 
employed  in  other  fevers,  and  in  acute  inflammations,  as  measles,  small- 
pox, pneumonia,  pleurisy,  rheumatism,  and  gout. 

In  acute  rheumatism,  when  the  pain  forbids  the  patient  to  be  moved, 
the  front  of  the  body  only  should  be  packed,  and  a  wet  cold  compress, 
renewed  every  two  or  three  hours,  should  be  wrapped  round  each  of  the 
painful  joints.  If  the  prejudices  of  the  patient's  friends  prevent  the  use 
of  the  cold  sheet,  the  body  should  be  sponged  with  tepid  or  cold  water 
several  times  a  day,  and  if  the  perspiration  is  abundant  and  foul,  soap 
should  be  used.  In  addition  to  sponging,  the  wet  cold  compress,  as  pre- 
viously described,  should  be  applied  to  the  painful  joints.  There  can  be 
no  question  of  the  superiority  of  this  treatment  over  that  of  swathing 
the  patient  in  flannel  clothes,  and  covering  him  in  blankets  to  make  liim 
sweat.  To  avoid  the  supposed  danger  of  catching  cold,  these  woollen 
clothes  are  worn  day  after  day,  till,  saturated  Avitli  putrefying  perspira- 
tion, the  stench  sickens  and  de-appetizes  the  patient,  and  a  crop  of  irri- 
tating miliary  vesicles  is  engendered,  which  breaks  the  patient's  sleep. 

In  pneumonia  some  pack  the  chest  only,  and  renew  the  cold  appli- 
cations hourly,  or  even  oftener;  a  mode  of  treatment  which  is  said  to 
remove  the  pain,  quiet  the  pulse,  calm  the  breathing,  and  reduce  the 
fever. 

When,  as  often  happens,  the  patient's  friends  object  to  the  cold  pack- 
ing through  fear  of  "  inflammation,"  or  of  ''  turning  the  disease  inwards," 
the  sheet  may  be  wrung  out  in  tepid  water,  and  by  the  time  it  is  spread 
for  the  reception  of  the  patient  it  will  be  sufficiently  cooled  to  answer  the 
purpose. 

A  pedestrian,  after  great  exertion,  will  find  it  an  agreeable  restorative, 
preventing  stiffness  and  aching  of  the  muscles,  to  strip  and  wrap  himself 
in  a  dripping  wet  cold  sheet,  well  rubbing  himself  afterwards;  but  if  stiff- 
ness still  remains,  a  few  drops  of  tincture  of  arnica  taken  internally  will 
remove  it. 

Cold  or  tepid  packing  is  useful  in  the  summer  diarrhoea  of  children. 

A  daily  cold  wet  pack  is  often  a  very  useful  application  in  chronic 
diarrhoea,  like  that  often  met  with  in  persons  coming  from  a  tropical 
climate,  and  due  probably  to  chronic  catarrh  of  the  intestinal  mucous 
membrane. 


COLD   BATHS   IN  FEVEES. 

The  elaborate  investigations  regarding  the  action  of  cold  applications 
in  fevers,  made  during  the  last  fifteen  years  in  Germany,  induce  me  to 
devote  a  separate  chapter  to  this  important  subject. 

These  investigations  confirm  the  conclusions' of  Currie  and  Jackson,  and 
give  precision  to  our  knowledge  concerning  the  employment  and  effects 
of  cold  to  the  surface.  This  treatment  has  been  employed  in  typhus, 
typhoid,  and  scarlet  fevers,  measles,  and  other  febrile  diseases.     More  re- 


46  COLD   BATHS    IX    FEVERS. 

cently,  Dr.  Wilson  Fox  and  others  have  cured  patients  suffering  from  the 
hyperpyrexia  occasionally  observed  in  rheumatic  fever,  a  condition,  owing 
to  its  sudden  onset  and  rapid  course,  hitherto  regarded  as  almost  neces- 
sarily fatal. 

Many  of  the  symptoms,  and  therefore  tlie  dangers,  of  fevers,  depend 
in  great  measure  on  the  elevation  of  the  temperature.  The  effects  of 
fever,  whether  specific  or  inflammatory,  are  due  either  to  elevation  of  the 
temperature,  to  the  specific  cause  of  the  fever,  or  to  the  inflammation. 
The  s^^mptoms  common  to  all  fevers  are  due  simply  to  the  elevated  tem- 
perature of  the  body,  whilst  the  characteristic  symptoms  are  due  either  to 
the  specific  poison,  or  to  the  inflammation.  This  increase  of  temperature 
affects  the  organs  in  a  twofold  manner;  in  the  first  place,  it  perverts,  de- 
presses, or,  if  the  rise  is  very  high,  abolishes  function;  and,  in  the  sec- 
ond place,  produces  fatty  degeneration,  or,  as  it  is  termed,  parenchymatous 
degeneration  of  all  the  tissues. 

That  the  common  symptoms  of  fever,  as  headache,  delirium, 
quick  pulse,  dry  skin,  and  general  weakness,  are  due  to  the  heightened 
temperature  is  well  shown  by  the  effects  of  a  treatment  which  will  re- 
duce this  abnormal  temperature:  that  is,  by  the  aid  of  the  cold  bath  or 
quinia  we  lower  the  temperature  to  the  normal  standard,  and  then  these 
pyrexial  symptoms  at  once  disappear. 

Fatty  degeneration  of  the  tissues  sets  in  during  the  progress  of  a  fever, 
especially  when  prolonged.  This  degeneration  has  been  observed  more 
particularly  and  fully  in  the  liver,  kidneys,  heart,  blood-vessels,  and  volun- 
tary muscles.  This  fatty  degeneration  is  in  all  probability  due  to  the 
fever,  for  the  degree  and  extent  of  the  changes  correspond  in  amount  to 
the  degree  and  duration  of  the  elevation  of  temperature;  and  similar 
changes  occur  when  the  temperature  of  an  animal  is  raised  by  keeping  it 
in  a  warm  chamber.  The  cells  of  the  liver  and  kidneys  become  cloudy, 
then  granular,  till  the  nucleus  becomes  obscured,  and  the  entire  cell  dis- 
tended with  granules,  and,  in  the  case  of  the  liver,  the  cells  contain  an 
excess  of  fat,  and  ultimately  many  cells  burst  and  perish.  The  muscular 
tissue  of  the  heart  and  of  the  voluntary  muscles  becomes  granular,  then 
fatty,  and  in  severe  cases  their  fibres  undergo  extensive  destruction. 

These  effects  of  high  temperature,  the  symptoms  and  the  deteriorating 
changes,  can  obviously  be  combated  only  by  means  which  either  lower  or 
23revent  the  undue  development  of  body-heat.  Foremost  amongst  these 
means  must  rank  cold  baths.  Employed  early  enough,  the\"  obviate  the  im- 
mediate depressing  effect  of  the  temperature  on  the  tissues,  and  prevent  the 
oncoming  of  parenclwmatous  degeneration.  Thus  they  reduce  the  frequen- 
cy of  the  pulse,  strengthen  the  heart,  and  so  avert  danger  from  failure  of 
the  heart,  and  from  hypostatic  congestion.  They  tend  likewise  to  prevent 
delirium,  and  to  produce  sound  and  refreshing  sleep;  to  improve  diges- 
tion and  assimilation,  and  to  promote  the  general  nutrition  of  the  body, 
and  thus  to  ward  off  or  to  lessen  the  risk  of  bed-sores  and  exhausting 
suppuration.  The  period  of  convalescence,  though  some  deny  this,  is 
shortened  by  promoting  assimilation,  and  thus  preventing  parenchymatous 
degeneration.  It  is  true  that  the  specific  poison  of  some  fevers,  as  typhoid 
or  t^^hus,  will  itself  probably  in  some  degree  affect  the  heart,  brain, 
and  functions  generally;  but  that  the  depression  of  the  heart  and  brain  is 
mainly  due  to  the  elevated  temperature  is  shown  by  the  great  abatement 
of  the  symptoms  referable  to  these  organs  when  the  temperature  is  reduced; 
though,  indeed,  it  may  be  plausibly  urged  that  without  elevation  of  tern- 


i 


COLD    BATHS    IN    FEVERS.  47 

perature  the  specific  poison  cannot  be  formed,  and  kence  anti-p_yrctic 
treatment  will  likewise  obviate  its  depressing  effects. 

Cold  bathing  is  applied  in  varionsways, — by  means  of  the  general  cold 
bath,  affnsion,  packing,  sponging,  and  by  the  nse  of  ice. 

Brand,  to  whom  the  revival  of  this  hydropathic  treatment  is  chiefly 
due,  has  employed  it  largely  in  typhoid  fever.  In  mild  cases  he  uses  cold' 
wet  compresses,  or  frequent -washing  with  cold  water,  or  repeated  pack- 
ings in  a  cold  wet  sheet,  or  a  warm  bath  gradually  cooled.  In  severe  cases 
he  recommends  affusion,  the  shower-bath,  or  the  general  cold  bath.  He 
generally  places  the  patient  in  a  sitz-bath,  and  pours  water  of  50°  to  55° 
Fall,  over  his  head  and  shoulders,  for  ten  or  fifteen  minutes,  wraps  him 
afterwards  unwiped  in  a  sheet,  and  covers  him  over  with  a  coverlet,  and 
to  his  chest  and  stomach  applies  compresses  wrung  out  of  iced  water;  but 
if  the  patient  complains  of  the  cold  he  covers  the  feet  more  warmly  or 
applies  hot  bottles  to  them. 

Hagenbach  employs  a  general  cold  bath  of  68°  to  77°  Fall,  for  ten  or 
twenty  minutes,  and  if  there  is  much  delirium,  or  coma,  he  at  the  same 
time  pours  cold  water  over  the  patient's  head.  He  disapproves  the  fre- 
quent cold  washings  and  packings,  asserting  that  they  abstract  but  little 
heat  and  that  they  fatigue  the  patient. 

The  method  employed  by  Ziemssen  and  Immerman  is  the  most  agreeable 
to  the  patient,  and  being  equally  efficient,  it  is  the  treatment  most  likely 
to  be  generally  adopted.  They  immerse  a  patient  in  a  bath  of  95°,  and 
in  the  course  of  twenty  to  thirty  minutes  gradually  cool  it  to  60°  Fah.  by 
the  addition  of  cold  water.  This  Ixitli  is  agreeable  to  fever  patients. 
These  observers  do  not  employ  affusion,  since  the  patient  much  dislikes 
it,  nor  cold  compresses,  since  these  do  not  affect  the  rectal  temperature. 
Cold  packings  they  find,  however,  do  reduce  the  temperature  of  the  rec- 
tum. For  young  children  and  old  persons  the  severity  of  the  application 
must  be  apportioned  to  the  strength  of  the  patient.  Brand  wraps  a  child 
in  a  wet  sheet,  and  placing  it  on  a  table  pours  cold  water  over  its  head. 
For  children  and  the  aged  Hagenbach  employs  for  half  an  hour  a  warm 
bath,  gradually  cooled  by  the  addition  of  cold  water  to  8Q°  or  75°  Fah. 
Weakly  patients  should  be  well  rubbed  on  leaving  the  bath.  Hagenbach 
adopts  this  treatment  whenever  the  temperature  rises  above  102°  Fah. ,  while 
Brand  recommends  it  whenever  the  temperature  mounts  above  103°  Fah. 

In  private  practice  I  find  the  assiduous  application  of  cold  cloths  wrung 
out  of  ice-cold  Avater  more  convenient  than  the  use  of  the  general  cold 
bath.  This  plan,  if  effectually  carried  out,  promptly  reduces  the  tem- 
perature. Thus,  by  the  method  I  am  about  to  describe,  I  have  seen  the 
temperature  in  hyperpyrexia  reduced  in  two  or  three  hours  from  107°  to 
101°,  or  even  lower. 

Dip  four  napkins,  or  small  towels,  into  iced  water,  and  wring  them 
nearly  dry,  so  that  they  may  not  drip  and  wet  the  bed,  then  ajjply  them 
one  below  the  other  from  the  chest  downwards.  As  soon  as  the  four 
cloths  are  disposed  over  the  chest  and  abdomen,  re-dip  and  re-wring  the 
uppermost,  then  the  second,  third,  and  fourth,  seriatim,  then  the  first 
again,  and  so  on  continuously.  Supplementary  napkins  to  the  head, 
thighs,  and  arms  will  of  course  still  more  quickly  lower  the  temperature; 
and  indeed,  should  be  employed  to  a  big  and  stout  patient,  since  large 
quantities  of  heat  have  to  be  withdrawn  through  the  bad  conducting  fatty 
layer  beneath  the  skin.  If  the  napkins  are  very  frequentl}^  changed,  this 
method  is  most  efficacious,  and  is  often  highly  agreeable  to  the  patient. 


48  COLD    BATHS    IN   FEVERS. 

being  in  this  respect  preferable  to  the  nsually  very  disagreeable  general  cold 
bath.  In  some  instances,  even  after  the  discontinuance  of  the  cold  cloths 
the  temperature  steadily  falls  for  several  hours. 

The  rcjietition  of  the  processes  must  be  regulated  by  the  subsequent 
course  of  the  fever.  If  in  three  or  four  hours  the  temperature  again 
rises  to  103°,  Brand  repeats  the  aifusion.  In  most  cases  he  finds  that  six 
affusions  are  enough,  and  afterwards  he  applies  cold  cloths  wrung  out  of 
water  at  60°  Fah.  two  or  three  times  a  day;  these  applications,  provided 
the  temperature  does  not  rise  higher  tlian  100°  Fah.,  being  made  smaller 
and  applied  less  frequently  as  the  case  progresses.  In  very  severe  cases 
the  affusion  must  be  employed  every  two  hours.  When  the  patient  is 
comatose  and  the  foregoing  treatment  fails  to  restore  consciousness,  Brand 
applies  a  cold  affusion   of  45°  Fah.  to  the  head  every  half-hour. 

Dr.  Stolir  recommends  the  continuance  of  this  treatment  in  typhoid 
even  to  the  middle  of  the  third  week;  but  it  maybe  required  longer,  and 
here  the  thermometer  is  the  test. 

Ziemssen  and  Immerman  find  that  with  their  plan  four  or  five  baths 
are  necessary  the  first  day,  and  that  subsequently  two  or  three  daily  will 
suffice,  the^  repetition,  however,  being  regulated  by  the  information 
afforded  by  the  thermometer.  They  prescribe  the  bath  at  6  a.m.,  and  1 
to  3  P.M.,  and  at  7  p.m.  Ziemssen  and  Immerman  found,  as  might  be  ex- 
pected, that  in  typhoid  the  degree  of  cooling  and  its  duration  differed 
according  to  the  patient's  age,  and  the  severity  of  the  case.  Thus  they 
find  the  usual  reduction  is  3.6°  Fah.  in  children,  and  2.5°  Fah.  in  adults. 
In  severe  adults  cases,  however,  the  temperature  falls  only  1.8°  Fah.,  and 
the  effect  of  the  bath  is  least  evident  in  cases  where  the  morning  remission 
is  slight.  In  severe  infantile  cases  they  fouiid  that  the  temperature  re- 
covers its  former  height  in  six  hours,  in  adult  cases  of  moderate  severity 
in  seven  hours,  and  in  severe  adult  cases  in  six  hours  and  a  half,  and  in 
cases  with  slight  morning  remissions  in  three  hours. 

A  single  bath  often  effects  a  considerable  reduction  of  the  febrile 
temperature.  Thus  Mosler  reduced  the  temperature  in  a  case  of  typhoid 
to  T°  Fall.,  and  the  late  Dr.  "Wilson  Fox,  in  one  of  his  interesting  cases 
of   rheumatic  hyperpyrexia,  13.4°  Fah. 

Dr.  Wilson  Fox's  exact  and  continuous  observations  on  some  cases  of 
rheumatic  hyperpyrexia  add  precision  to  our  knowledge  of  the  effects  of 
cold  baths.  He  has  shown  that  the  fall  of  temperature  continues  every 
six  or  more  degrees,  forty  or  fifty  minutes  after  the  discontinuance  of  the 
bath.  It  is  important,  therefore,  to  obserxe  the  temperature  in  the  rec- 
tum while  the  patient  is  in  the  bath,  and  to  remove  him  before  the  heat 
is  too  far  reduced,  lest  too  great  a  withdrawal  of  it  might  lead  to  collapse. 
This  indeed  appears  sometimes  to  occur,  for  we  read  of  cases  becoming 
cvanotic,  although  German  observers  aver  that  this  is  not  important,  and 
advise  in  such  a  case  the  application  of  warm  bottles  to  the  extremities. 
Still  I  am  convinced  that  it  is  important  to  avoid  depressing,  to  this  haz- 
ardous extent,  as  I  have  seen  a  child,  suffering  from  scarlet  fever,  killed 
by  an  over  energetic  employment  of  cold. 

German  observers  show  conclusively  that  this  treatment  greatly  reduces 
the  mortality  of  typhus  and  typhoid  fever.  Thus  Brand  treated  170  cases 
of  typhus,  and  Bartels  treated  thirty  cases  of  typhoid  without  a  single 
death.  The  mortality  of  Hagenbach's  typhus  patients  was  five  per  cent, 
provided  the  cases  were  treated  early,  and  Dr.  Stohr  reduced  the  mortality 
of  his  patients  from  thirty  to  six  per  cent.,  and  the  results  he  thinks 


COLD    BATHS    IN"    FEVERS.  49 

would  have  been  still  more  favorable  could  he  have  treated  some  of  his  cases 
earlier.  Liebermeister  lessened  his  mortality  from  twenty-seven  to  eight 
per  cent. 

Notwithstanding  the  enthusiastic  laudation  of  the  cold-bath  treatment 
of  fevers  by  German  writers,  this  plan  is  not  at  present  commonly  employed 
in  this  country.  If  there  is  reason  to  hesitate  whether  we  should  treat  the 
acute  specific  fevers  or  inflammatory  fever  by  this  heroic  method,  there  can 
be  no  question  respecting  its  great  value  in  the  treatment  of  hyperpyrexia. 
This  most  dangerous  condition  generally  arises  from  rheumatic  fever,  and 
to  it,  no  doubt,  most  of  the  fatal  cases  of  rheumatism  are  attributable. 
It  may  occur,  however,  in  the  course  of  any  fever;  and  may,  indeed,  seize 
a  person  apparently  in  perfect  health.  The  first  case  of  hyperpyrexia 
ever  recorded  occurred  whilst  I  was  resident  officer  at  University  College 
Hospital,  and  this  was  an  instance  of  a  sudden  attack  in  a  woman  who 
had  recovered  from  rheumatic  fever,  and  was  on  the  point  of  leaving  the 
hospital  apparently  in  fair  health.  On  being  called  to  her  assistance  I 
was  surprised  at  the  pungent  burning  heat  of  her  skin,  and  to  my  aston- 
ishment found  her  temperature  to  be  110°,  and  a  little  later  111°.  She 
died  in  eight  hours.  This  phenomenon,  so  startling  then  when  hyper- 
pyrexia was  unheard  of,  has  beeji  noticed  in  hundreds  of  cases.  Hyper- 
pyrexia not  uncommonly  attacks  children  just  previously  in  apparent  good 
health.  I  have  often  seen  children  in  severe  convulsions,  and  have  found 
their  rectal  temperature  107°  and  108°  Fah.  The  hyperpyi-exia  may  have 
been  due  to  the  onset  of  an  acute  specific  fever  or  of  an  acute  inflammation, 
but  as  these  children  all  died  it  was  impossible  to  ascertain  the  cause  of 
the  onset  of  the  fatal  hyperpyrexia.  Ordinarily,  no  doubt,  hyperpyrexia 
occuijs  in  the  course  of  a  fever,  and  generally,  perhaps,  when  the  tempera- 
ture runs  very  high;  but  this  by  no  means  rarely  comes  on  in  rheumatic 
fever  when  the  fever  is  moderate  and  the  symptoms  mild.  In  a  typical 
case  of  hyperpyrexia  the  temperature  rapidly  rises,  reaching  in  the  course 
of  a  few  hours  110°,  112°,  or  even  higher.  This  severe  fever  perturbs 
and  depresses  the  functions.  At  first  the  patient  is  restless  and  delirious, 
the  delirium  being  either  slight  or  so  decided  that  he  must  be  restrained. 
Sometimes  before  delirium  the  patient  becomes  blind.  The  delirium  soon 
subsides,  he  becomes  quite  unconscious;  the  pulse,  at  first  full  and  bound- 
ing, becomes  exceedingly  frequent  and  feeble;  the  respirations  are  much 
hurried;  the  skin  is  generally  dry;  but  it  may  be  drenched  in  sweat. 
Then  the  coma  deepens,  the  breathing  becomes  more  frequent  and  shallow, 
and  in  few  hours  the  patient  dies.  Not  a  single  case  of  hyperpyrexia,  as 
far  as  I  know,  recovered  till  Dr.  Wilson  Fox  first  treated  his  cases  with 
the  cold  bath.  Since  then  this  treatment  has  been  largely  employed,  and 
with  a  larger  measure  of  success;  indeed,  it  is  not  an  exaggeration  to  say 
that  the  majority  of  the  cases  thus  treated  have  been  saved.  In  my  own 
practi<;e,  in  a  considerable  number  of  cases,  this  treatment  has  generally 
proved  successful;  and  it  is  a  source  of  great  gratification  to  me  that  by 
means  of  Dr.  Fox's  treatment  I  have  certainly  saved  many  lives.  In 
hospital  we  mainly  use  the  general  cold  bath,  but  in  private  practice  the 
application  of  iced-cold  cloths  in  the  way  previously  described  will  I 
believe,  prove  more  convenient,  pleasant,  and  safe.  Several  cold  baths' 
are  usually  necessary,  for  after  the  reduction  of  the  temperature,  and  con- 
sequent removal  of  the  sjanptoms,  the  temperature  generally  rises  again. 
It  is  interesting  to  note  the  passing  away  of  the  deadly  symptoms  as  the 
temperature  falls.  The  patient  wakes  out  of  his  coma,  and  next  his  mind 
4 


50  AVAR.M    BATH   AND    THE    HOT    BATH. 

becomes  quite  clear;  his  pulse  falls  and  becomes  stronger,  and  he  passes 
quieklv  from  most  imminent  peril,  from  the  very  shadow  of  death,  to  his 
condition  })revious  to  the  onslaught  of  the  hyi)erpyrexia.  Though  T  have 
said  several  cold  baths  are  generally  needed  completely  to  subdue  the 
hyperpyrexia,  yet  in  three  cases  after  the  first  reduction  of  the  tempera- 
ture the  hyperpyrexia  did  not  return,  but  the  })atients  forthwith  passed 
at  once  from  a  condition  of  urgent  danger  into  convalescence,  without 
undergoing  a  single  unfavorable  symptom. 

This  treatment  not  only  reduces  the  excessive  heat  of  fever,  but  it 
allays  the  nervous  symptoms,  limits  the  wasting,  and  Brand  says  it  also 
prevents  meteorism,  bleeding,  and  lessens  diarrhoea  in  typhoid.  On  the 
other  hand,  Hagenbach  and  Jurgensen  assert  that  this  treatment  fails  to 
lessen  the  meteorism  and  diarrhcjea  in  typhoid  fever,  and  to  reduce  the 
size  of  the  spleen  and  the  dicrotism  of  the  pulse.  All  observers  agree  that 
cold  baths  do  not  shorten  the  course  of  typhoid,  typhus,  and  other  acute 
specific  fevers,  but  Brand  asserts,  while  Hagenbach  denies,  that  they 
shorten  the  stage  of  convalescence. 

This  treatment,  it  is  said,  rarelv,  if  ever,  induces  either  bronchitis 
or  pneumonia,  and  the  co-existence  of  either  with  a  fever  does  not  con- 
tra-indicate  the  use  of  cold  baths.  Liebermeister  even  says  that  hypo- 
static congestion  or  pneumonia  afford  no  reason  for  suspending  the  baths — 
that,  indeed,  under  their  use,  hypostatic  pneumonia  sometimes  disappears. 
I  have  several  times  seen  all  the  signs  of  double  pneumonia  arise  after  the 
bath;  for  instance,  dulness.  tubular  breathing,  bronchophony,  and  yet 
these  patients  have  done  well. 

LudAvig  and  Schroder  find  that  this  treatment  of  fevers  greatly  reduces 
the  quantity  of  carbonic  acid  exhaled  by  the  lungs  and  the  solid  constit- 
uents of  the  urine,  and  thus  lessens  the  tissue  change;  a  very  singular 
fact,  since  cold  baths,  in  health,  have  the  very  opposite  effect.  Dr.  Fox 
observes  that  sometimes  the  rectal  temperature  rises  a  little  directly  the 
patient  is  2:)laced  in  the  bath;  and  Dr.  Fiedler  and  Hartenstein  point  out 
that  immediately  after  the  bath  the  axillary  is  much  lower  than  the  rectal 
temperature,  but  half  an  hour  aftei-wards  this  discrepancy  is  reversed, 
the  rectal  temperature  becoming  from  1°  to  2°  Fah.  lower  than  the  axil- 
lary, and  so  continuing  during  three-quarters  of  an  hour. 


THE  WAEM  BATH  AXD  THE  HOT  BATH. 

The  effects  of  heat  on  the  body  are,  of  course,  for  the  most  part,  the 
opposite  of  cold.  By  surrounding  the  body  with  a  temperature  higher 
than  its  own,  the  destruction  of  the  tissues  by  oxidation  is  considierably 
diminished.  Moreover,  experiment  has  shown  that  increased  heat  im- 
pedes or  destroys  the  electric  currents  in  the  nerves,  Avhence  it  may  be 
fairly  presumed  that  when  subjected  to  this  influence  they  are  less  able 
to  conduct  impressions  either  to  or  from  the  brain.  These  two  considera- 
tions may  perhaps  account  for  the  enfeebling  influence  on  the  body. 

The  general  warm  bath,  if  not  too  hot,  is  at  first  highly  pleasurable, 
but  if  unduly  indulged  in,  throbbing  at  the  heart  and  in  the  large  vessels 
soon  comes  on,  with  beating  in  the  head,  and  a  sense  of  oppression  and 
anxiety.      These   sensations,    however,    when    perspiration    breaks    out. 


WARM    BATH    AND    THE    HOT    BATH.  51 

greatly  diminish  or  altogether  cease;  but  if  the  bath  is  continued  too  long, 
the  foregoing  uncomfortable  sensations  return,  accompanied  by  great  pros- 
tration, even  to  the  extent  of  fainting;  the  pulse  becomes  greatly  accelerated 
and  enfeebled,  while  the  temperature  of  the  body  rises  very  consider- 
ably, and,  if  the  heat  of  the  bath  is  great,  may  even  reach  104°  Fah., 
that  is,  to  a  severe  fever  height. 

Warm  baths  are  employed  in  Bright's  disease  to  increase  the  perspira- 
tion, so  as  to  lessen  the  dropsy,  and  carry  oif  from  the  blood  any  dele- 
terious matter  retained  in  it  through  the  inaction  of  the  kidneys. 

We  must  always  bear  in  mind  the  purpose  of  the  hot  bath.  It  is  too 
much  the  ]n-actice  to  employ  hot  baths  in  Bright's  disease  before  the  occur- 
rence either  of  dropsy  or  ura?mia.  As  the  baths  weaken  the  patient  con- 
siderably, they  increase  ana?mia  and  so  favor  dropsy.  They  should  only 
be  employed  when  dropsy  or  urajmic  symptoms  are  marked.  Then,  no 
doubt,  they  are  often  very  serviceable  by  removing  a  large  quantity  of 
water  from  the  blood,  and  lessening  the  hydra^mia  on  which  the  dropsy 
depends;  but  whilst  of  undoubted  service,  if  often  repeated,  they  induce 
much  weakness.  In  my  experience  baths  are  greatly  inferior  to  the  plan 
of  making  incisions  over  each  external  malleolus  in  the  way  described  in 
the  section  on  acupuncture.  This  treatment  reduces  the  dropsy  much 
more  speedily,  and  far  more  certainly. 

The  hot  bath  is  also  used  in  nra?mia  with  the  view  of  eliminating  the 
urea  through  the  skin.  There  can  be  little  doubt  that  this  treatment  is 
serviceable  in  removing  many  of  the  cerebral  manifestations  of  uraemia; 
but  it  is  very  questionable  whether  the  baths  so  act  by  eliminating  urea. 
It  is,  at  best,  doubtful  whether  the  uraemic  symptoms  depend  on  the  re- 
tention of  urea  in  the  blood;  moreover,  it  is  uncertain  to  what  extent,  if 
any,  the  bath  can  eliminate  nitrogenous  products  through  the  skin.  It 
is  certain  that  in  health  very  little,  if  any,  iirea  escapes  by  the  skin,  though 
it  is  probable  that  in  some  cases  of  Bright's  disease  urea  is  actually  sepa- 
rated with  the  perspiration.  Bartels  records  cases  where  crystals  of  urea 
covered  the  face,  and  by  their  accumulation  on  the  beard  gave  it  a  f I'osted 
appearance. 

The  general  warm  bath  is  of  signal  service  either  in  simple  or  inflam- 
matory fever  of  children.  If  a  child  is  not  very  weak,  a  bath  night  and 
morning,  for  a  time  varying  from  five  to  ten  minutes,  soothes  and  quiets, 
and  often  brings  on  refreshing  sleep.  In  the  febrile  diseases  of  grown-up 
people,  it  is  generally  difficult  to  employ  the  general  warm  bath,  but,  in 
its  stead,  sponging  with  hot  water  often  induces  perspiration,  calming  at 
the  same  time  the  restlessness  of  the  patient,  and  favoring  sleep.  The 
same  means  will  soothe  the  restlessness  of  convalescence  and  induce  sleep. 

In  inflammatory  affections  warm  or  tepid  baths  are  supposed  to  act  by 
dilating  the  blood-vessels  of  the  skin,  and  so  withdrawing  blood  from  the 
internal  organs,  including  of  course  the  inflamed  organ,  and  thus  by 
lessening  the  amount  of  blood  in  any  given  part  the  bath  diminishes  in- 
flammation. Further,  by  withdrawing  blood  from  the  brain  the  warm 
bath  favors  sleep. 

The  warm  bath  mitigates  or  removes  the  pain  of  colic,  renal,  biliary, 
or  otherwise.  Whether  its  effects  in  relaxing  spasm  are  induced  through 
its  soothing  influence  on  the  skin,  or  from  weakness  caused  by  the  bath, 
is  difficult  to  say;  the  bath  certainly  seems  to  ease  the  pain  before  any  no- 
ticeable weakness  is  produced.  In  skin  diseases  of  various  kinds  the  general 
warm  bath  is  invaluable.     In  psoriasis,  eczema,  icthyosis,  urticaria,  lichen. 


52  WARM    liATII    AND    THE   HOT    BATH. 

prurigo,  and  scabies,  it  may  generally  be  employed  Avith  benefit.  It  is 
especially  useful  in  the  acute  state  of  eczema  and  psoriasis.  Rain  or 
boiled  water  should  be  i^sed;  but  if  tiiese  are  not  available,  the  water 
should  be  made  more  soothing  by  the  addition  of  small  pieces  of  common 
Avashing  soda,  gelatin,  bran,  or  potato-stai'ch.  These  baths  allay  inflam- 
mation and  itching.  The  body  must  be  dabbed  dry  with  soft  towels.  If 
there  is  much  itching,  flannel  should  not  be  worn,  .and  scratching  should 
be  prohibited. 

It  has  been  recommended  to  keep  quiet  a  patient  Avith  se\'ere  burns 
immersed  for  days  in  the  warm  bath;  this  treatment  is  said  to  ease  pain, 
diminish  suppuration,  promote  the  healing  process,  and  to  lessen  the  con- 
traction of  the  cicatrix. 

As  a  means  of  oliA-iating  the  A'arious  symptoms  occurring  at  the  change 
of  life.  Dr.  Tilt  recommends  the  general  Avarm  bath  of  90°  to  95°  Fah.  for 
an  hour  once  a  Aveek,  so  as  to  promote  free  perspiration. 

The  hot  sitz-bath  is  very  useful  in  cystitis  and  dysmenorrhoea.  It 
allays  pain  and  the  incessant  desire  to  micturate  and  straining.  If  the 
symptoms  are  urgent  it  may  be  employed  tAvo  or  three  times  a  day  from 
tAventy  to  thirty  minutes  in  cystitis,  and  even  longer  in  dysmenorrhoea. 

The  local  Avarm  bath  is  used  for  a  variety  of  purposes.  It  is  hardly 
necessary  to  refer  to  the  common  household  practice  of  putting  the  feet 
into  hot  Avater  just  before  going  to  bed^  to  induce  general  perspiration, 
and  so  relieve  catarrh.  The  hot  foot-bath,  or  the  sitz-bath,  is  of  great 
service  Avhen  the  menstrual  floAV  is  either  deficient  or  absent.  To  this 
bath,  mustard  may  be  added  Avith  advantage:  but,  as  the  late  Dr.  Graves 
insisted,  this  stimulating  bath  should  be  used  only  at  the  menstrual 
period.  Employed  nightly,  or  night  and  morning,  for  six  days,  com- 
mencing one  or  tAvo  days  before  the  period  begins,  this  mustard  bath  is  a 
very  useful  auxiliary  to  other  treatment,  and  often  succeeds  in  establish- 
ing menstruation.  The  sitz-bath  is  often  effectual  Avlien,  through  expos- 
ure to  cold,  or  from  other  circumstances,  the  menstrual  floAv  is  suddenly 
stopped,  to  the  patient's  great  annoyance  and  sulfering.  Immersion  in 
water  as  bot  as  can  be  borne  is  said  to  be  very  useful  for  sprains,  in  their 
earliest  stage. 

Dr.  Druitt  points  out  that  sponging  the  body  with  very  hot  water  Avill 
for  some  hours  diminish  the  excessive  perspiration  of  phtbisis. 

Hot  water  to  the  legs  and  feet  sometimes  removes  headache,  and  ac- 
cording to  Dr.  Graves  relieves  distressing  palpitation. 

Sponging  the  face,  temples,  and  neck  with  water,  as  hot  as  can  be 
borne,  often  relieves  the  headache  of  influenza,  catarrh,  and  other  diseases. 

The  immersion  of  the  feet  in  hot  water,  with  or  Avithout  mustard, 
will  often  arrest  nose -bleeding.  The  vessels  of  the  loAver  extremities, 
and  probably  reflexly  the  vessels  of  the  j^elvic  organs,  become  much  di- 
lated, and  hence  blood  is  Avithdrawn  from  the  upper  part  of  the  body, 
and  vascular  pressure  is  lessened. 

Brine  baths,  as  those  at  Droitwich,  are  very  useful  in  chronic  rheu- 
matism, rheumatoid  arthritis,  gout,  and  sciatica.  A  brine  bath  can  be 
made  by  adding  from  twenty  to  thirty  pounds  of  common  salt  to  thirty 
gallons  of  Avater  at  a  temperature  of  100°  Fah.  The  patient  should  take 
one  daily  from  twenty  minutes  to  half  an  hour's  duration,  gradually  ex- 
tending the  time  to  an  hour.  This  produces  no  depression  like  a  plain 
hot-water  bath.     On  the  contrary,  it  exhilarates.    When  only  one  or  tAvo 


HOT-AIR    AND    VAPOR    BATHS.  53 

parts  are  affected  or  painful,  as  the  ankle  or  wrist,  I  have  found  that  the 
immersion  of  the  parts  in  a  saline  bath  gives  much  relief.  Many  chronic 
cases  of  sciatica  are  more  effectually  relieved  by  the  bath  than  by  any 
other  treatment.  The  efficacy  of  the  salt-bath  is  the  more  singular  as 
the  salt  is  the  efficient  constituent ;  hot  baths  will  not  replace  the  saline 
baths;  yet  little  or  none  of  the  salt  being  absorbed,  this  bath  must  exer- 
cise the  topical  influence  action  of  salt  on  the  skin. 


HOT-AIR  AND   VAPOR   BATHS. 

The  hot-air  bath  very  generally  succeeds  in  promoting  free  perspira- 
tion; but  when  it  is  difficult  thus  to  establish  a  free  flow  of  perspiration, 
the  hot-air  bath  may  be  preceded  by  the  general  warm  bath. 

Vapor-baths  are  used  for  the  same  purpose,  and  are  less  depressing 
than  the  general  warm  bath.  Vapor  and  hot-air  baths  produce  much 
less  elevation  of  the  temperature  of  the  body,  a  circumstance  which 
j)robably  explains  their  difference  in  this  respect. 

The  usual  hot-air  bath,  with  the  lamp  or  hot  bricks,  does  not  in  most 
instances  cause  heat  enough  to  induce  copious  sweating.  Gas  is  more 
efficient,  but  it  is  difficult  to  handle  unless  with  a  special  apjjaratus. 
The  lamp-bath  under  a  cape  often  induces  very  free  sweating  if  the 
jiatient  is  strong  enough  to  sit  up.  The  copious  perspiration  thus  in- 
duced is  very  efficacious  in  relieving  ura^mic  symptoms,  and  this  treat- 
ment is  much  more  efficient  and  less  depressing  than  hydrogogue  pur- 
gation. 


54  SHOWER.  DOUCHE,  AND    SPONGE   UATHS. 


SHOWER,  DOUCHE,  AND  SPONGE  BATHS. 

The  forcible  impact  of  water  upon  the  body,  and  the  impression  it 
makes  on  the  nerves,  or,  to  use  the  general  expression,  tlie  shock  it  pro- 
duces, is  sometimes  very  great,  sufficient  sometimes,  even  with  strong  and 
healthy  jiersons,  to  produce  considerable  depression  and  languor,  lasting 
hours  and  occasionally  days. 

The  shower-bath  is  a  remedy  not  much  used,  patients  ordinarily  mani- 
festing great  repugnance  to  it.  The  sponge- bath,  or  the  local  douche, 
may  usefully  supply  its  place. 

In  the  sponge-bath  we  have  all  the  conditions  of  the  common  batli. 
Both  are  cleansing,  bracing  and  invigorating;  and  the  action  of  each  is 
identical. 

The  sponge-bath  is  often  employed,  not  merely  for  its  tonic  effects, 
but  for  the  sake  of  the  shock  it  causes  to  the  nervous  system. 

In  the  treatment  of  laryngismus  stridulus,  cold  sponging  is  more  suc- 
cessful than  anything  else.  The  practice  of  confining  little  children  thus 
affected  in  a  warm  close  room,  sousing  them  in  warm  baths  several  times 
a  day,  is  positively  injurious,  and  inevitably  aggravates  the  severity  and 
frequency  of  the  crowing  breathing.  Cold  sponging  twice  or  thrice  daily, 
according  to  the  severity  of  the  case,  will  scarcely  ever  fail  to  modify  the 
disease,  however  severe  the  attack.  So  prompt  is  the  relief  of  cold 
sponging  that  a  child  subject  to  hourly  attacks  dunng  the  day,  and  to 
ceaseless  attacks  at  night,  is  frequently  instantaneously  delivered  from 
them.  At  all  events  a  decided  improvement  always  occurs,  and  the  in- 
tervals between  the  attacks  are  much  prolonged;  it  rarely  happens  that 
the  strident  crowing  resists  this  treatment  more  than  two  or  three  days. 
The  mother  should  be  directed  to  keep  the  child  out  of  doors  the  greater 
part  of  the  day,  no  matter  how  cold  the  weather — indeed  the  colder  the 
better.  Laryngismus  seldom  attacks  children  more  than  a  year  old.  At 
so  tender  an  age  it  might  be  feared  that  they  would  run  great  danger  of 
catching  cold  from  the  sponging  treatment;  but  no  such  fears  need  be 
entertained.  With  the  necessary  precautions,  even  the  youngest  child 
may  be  sponged  with  perfect  safety  several  times  a  day.  Nor  does  a  child 
catch  cold  even  in  the  coldest  weather  when  carried  out  of  doors;  but  one 
prone  to  bronchitis  had  better  be  kept  indoors  when  the  weather  is  very 
severe,  and  should  undergo  the  cold-water  sponging  only.  After  a  very 
extensive  experience  of  this  treatment  I  have  rarely  found  that  children 
suffering  from  laryngismus  catch  cold,  and  in  such  exceptional  cases  the 
catarrhal  symptoms  have  been  insignificant.  This  treatment  frequently 
saves  life,  and  averts  not  only  the  crowing  breathing,  but  dangerous  symp- 
toms, such  as  partial  convulsions  in  the  form  of  carpopedal  contractions 
and  squinting,  for  laryngismus,  when  fatal,  generally  destroys  by  exciting 
an  attack  of  general  convulsions.  Laryngismus  stridulus  is  sometimes  ac- 
companied, and  is  indeed  apparently  induced,  by  laryngitis,  indicated  b}^ 
the  peculiar  hoarse  voice.  In  such  cases  cold  sponging  must  be  cautiously 
used,  for  it  often,  though  by  no  means  invariably,  increases  the  laryngitis, 
and  therefore  the  laryngismus.  Among  the  poorer  classes,  at  certain  sea- 
sons of  the  year,  laryngismus  is  one  of  the  most  common  causes  of  convul- 
sions, Avhich  tend  so  often  to  a  fatal  issue. 

The  surest  and  ^speediest  way  of  arresting  a  paroxysm  of  crowing 
breathing  is  to  dash  cold  water  over  the  child.    At  the  onset  of  a  jxxroxysm 


SHOWER,  DOUCHE,  AND    SPONGE    BATHS.  55 

cold  water  snonld  l)e  daslied  on  the  child's  face;  and  if  this  does  not  at 
once  arrest  the  attack,  water  should  be  applied  to  the  whole  body.  Laryn- 
gismus fortunately  prevails  In  the  early  spring,  when  the  cold  weather 
itself  is  a  ready  source  of  cure. 

Since  by  this  treatment  laryngismus  is  usually  cured  at  once,  or  rarely 
lasts  more  than  a  few  days,  it  is  obvious  that  cold  water  does  not  act  as  a 
mere  tonic,  although  in  this  respect  it  is  very  useful,  because  laryngismus 
generally  attacks  weakly,  sickly  and  rickety  children. 

Any  irritation  aggravates  laryngismus,  and  impedes  its  cure.  Hence, 
if  the  relief  from  cold  sponging  is  less  marked  than  might  be  expected, 
some  other  sources  of  irritation  should  be  sought  for  and  removed.  The 
gums  if  swollen,  red  and  hot,  must  be  freely  lanced  and  the  cut  main- 
tained open,  for  if  they  close  the  irritation  recurs;  thus  it  is  necessary  to 
lance  the  gums  every  few  days.  Worms  must  be  removed,  and  the  faulty 
state  of  the  mucous  membrane  favoring  their  production  treated.  At  the 
cutting  of  each  tooth,  laryngismus  is  apt  to  recur  in  spite  of  cold  spong- 
ing, but  the  relapse  is  seldom  severe.  When  the  tension  of  the  gums  is 
removed,  and  the  tooth  set  free,  the  fit  ceases.  Irregularities  of  the  bowels, 
diarrhoea,  constipation,  flatulence,  etc.,  tend  to  increase  the  frequency  of 
crowing,  and  to  render  the  case  less  amenable  to  cold  sponging. 

It  may  here  be  useful  to  advert  to  a  condition,  not  uncommon  in  in- 
fants. An  infant  in  poor  health  frequently  wakes  up  at  night  from  "a, 
catch  in  the  breath."  From  some  unexplained  reason,  it  cannot  for  a 
time  get  its  breath,  and  wakes  up  with  a  loud  snore.  This  condition  is  alto- 
gether different  from  that  of  laryngismus  stridulus,  and  the  fault  appears 
to  lie  in  the  soft  palate,  not  in  the  larynx;  moreover  it  is  not  due  to  en- 
larged tonsils,  as  this  "  catch  in  the  breath  "  occurs  in  children  of  ten- 
der age,  long  before  the  morbid  condition  of  the  tonsils  takes  place.  Cold 
sponging  night  and  morning,  will  improve  or  even  cure  this  curious  com- 
plaint. 

Cold  sponging,  several  times  a  day,  holds  also  deservedly  a  very  high 
place  in  the  treatment  of  chorea.  It  is  at  present  impossible  to  decide 
whether  its  efficacy  is  due  solely  to  its  tonic  properties,  or  whether  the 
shock  plays  any  part  in  promoting  the  cure.  Of  the  value  of  this  treat- 
ment there  is  no  question,  yet  circumspection  must  be  exercised  or  the 
patient  may  be  made  worse.  It  must  be  avoided  if  there  is  any  rheuma- 
tism, which  is  generally  made  worse  by  cold  sponging,  thus  inducing  an 
increase  of  choreic  movements.  If  there  is  no  fever,  and  no  pain  in  any 
of  the  joints,  then  cold  sponging  may  be  reasonably  expected  to  yield 
most  satisfactory  results. 

In  the  treatment  of  rickets,  cold  sponging,  by  virtue  of  its  tonic  prop- 
erties, holds  a  very  high  place.  Here,  again,  care  must  be  observed,  or 
much  harm  may  be  done.  We  must  remember  that  a  rickety  child  is 
often  not  only  very  weak,  but,  on  account  of  its  tender  years,  very  im- 
pressionable, and  for  these  reasons  it  is  important  to  adapt  the  application 
of  the  cold  sponging  to  the  patient's  condition.  If  the  child  is  old  enough 
to  stand,  he  should  be  placed  up  to  the  ankles  in  warm-  water  before  a 
good  fire,  and  then,  except  the  head  and  face,  be  sponged  all  over  with 
cold  water  from  two  to  five  minutes;  he  should  then  be  carefully  wiped 
dry,  and  well  rubbed  with  a  soft  towel.  If  weakly,  the  child  may  be  re- 
placed for  a  short  time  in  a  warm  bed,  to  encourage  reaction.  The  spong- 
ing should  be  administered  as  soon  as  the  child  leaves  his  bed;  but  if  very 
weak  or  unaccustomed  to  sponging,  it  is  advisable  to  give  a  light  and  early 


56  SHOWER,  DOUCHE,  AND    SPONGE   BATHS, 

breakfast  about  an  bour  beforehand.  There  is  another  excellent  method 
of  administering  cold  sponging  to  weak  persons  or  to  timid  children,  and 
therefore  a  plan  to  be  adopted  Avhen  this  agent  is  used  in  the  treatment 
of  chorea.  The  water,  at  first  tepid,  should  be  gradually  reduced  in  tem- 
perature by  drawing  olf  the  warm  water  and  substituting  cold.  The 
shock  is  thus  avoided,  whilst  the  tonic  virtue  of  the  bath  is  obtained. 
This  latter  method  succeeds  admirably  with  timid  children,  who.  often 
much  fi-ightened  by  the  bathing,  sometimes  scream  so  violently  as  to  lead 
their  friends  to  fear  an  attack  of  convulsions. 

Cold  sponging  is  very  invigorating  for  adults  in  impaired  health;  it  is 
useful  also  in  ansemia,  leucorrhoea,  amenorrhcjea,  spermatorrlicea,  and  in 
that  low  nervous  state  induced  by  working  in  hot,  close,  ill-ventilated 
rooms. 

In  cold  weather,  the  water  at  first  should  be  made  a  little  warm,  after- 
ward the  temperature  should  be  daily  lowered.  By  a  little  light  food 
taken  about  an  hour  before  the  bath,  and  after  its  completion  a  return 
to  bed  for  half  an  hour  to  restore  warmth  to  the  skin  and  extremities,  will 
generally  prevent  depressing  effects  on  weakly  subjects. 

Affusion  and  the  Douche. — Cold  water  thus  applied  impinges  on  the 
body  with  considerable  force,  and  the  resulting  nervous  impression  is  cor- 
respondingly considerable.  Water  is  directed  against  the  body  in  a  full 
stream,  and  is  applied  sometimes  to  every  part  of  the  surface  in  succession. 
The  depression  it  produces  is  too  great  to  admit  of  its  frequent  employ- 
ment. It  is  generally  modified,  and  the  cold  affusion  used  in  its  place: 
cold  water  is  dashed  in  pailfuls  over  the  surface  of  the  body.  Affusion  is 
recommended  in  sunstroke  when  a  patient  is  struck  down  and  rendered 
unconscious.  Many  years  ago  cold  afi:usion  was  employed  in  the  treat- 
ment of  the  acute  specific  fevers,  and  was  especially  recommended  in 
scarlet  feyer, — a  well-tried  mode  of  treatment  coming  down  to  us  sanc- 
tioned by  the  authority  of  many  of  the  ablest  physicians  of  the  past  gene- 
ration. Yet  in  the  present  day  the  reaction  against  all  energetic  treatment 
is  so  great  that  this  means  is  now  very  rarely  adopted.  Fears  are  expressed 
lest  serious  consequences  should  ensue;  but  if  the  affusion  is  employed 
at  the  right  period,  no  apprehension  need  be  entertained,  as  the  experi- 
ence of  Currie  and  Jackson  abundantly  testifies.  It  should  be  employed 
during  the  early  days  of  the  fever,  when  the  skin  is  hot  and  the  rash 
bright  red. 

Currie  and  Jackson  recommended  that  the  patient  should  be  stripped, 
and  that  four  or  five  gallons  of  very  cold  water  should  be  dashed  over  him, 
a  process  to  be  repeated  again  and  again  when  the  heat  of  the  surface  re- 
turned. This  treatment  diminishes  the  fever,  and  sometimes,  it  is  stated, 
even  extinguishes  it. 

The  douche  and  affusion  are  generally  employed  for  their  local  effects. 
They  are  of  the  greatest  service  to  rouse  a  patient  from  the  stupor*  of 
drunkenness,  or  from  that  of  opium  poisoning;  when  a  certain  stage  of 
the  poisoning  has  been  reached  no  other  treatment  is  so  efficacious.  Ex- 
cessive tippling  or  an  overdose  of  opium  induces  stupor  more  or  less  pro- 
found, when  the  movements  of  respiration,  at  first  languidly  performed, 
soon  stop,  and  death  by  asphyxia  results.  At  this  most  critical  stage, 
cold  affusion,  or  the  cold  douche,  applied  freely  to  the  head,  is  generally 
sufficient  to  remove  the  conditions  within  the  skull  on  which  the  stupor 
depends.  Consciousness  is  restored,  the  breathing  simultaneoi;sly  again 
becomes  natural,  and  for  a  time,  at  least,  the  fear  of  a  speedily  fatal  ter- 


SHOWER,  DOUCHE,  AND    SPONGE    BATHS.  57 

miuiition  is  set  at  rest.  The  water  should  be  poured  on  the  head  from  a 
good  lieight,  so  as  to  secure  as  great  a  shock  as  possible.  The  vigor  of 
the  application  must  be  regulated  by  the  pulse  and  general  state  of  the 
patient.  The  breathing  becomes  deeper  and  more  frequent,  the  livid, 
bloated  aspect  of  the  face  soon  disappears,  while  the  pulse  grows  in 
strength.  It  often  happens  that  relapses  occur,  when  the  affusion  must 
be  again  and  again  employed,  so  as  to  sustain  life  long  enough  to  admit  of 
the  elimination  of  the  poison.  If  promptly  and  efficiently  applied,  life 
may  be  saved  even  in  the  most  unpromising  cases.  It  is  all-important  to 
ply  the  water  abundantly  for  some  time,  and  from  a  good  height.  Some 
time  may  elapse  before  any  good  effects  become  visible,  but  if  the  pulse 
and  breathing  improve,  or  become  no  worse  than  before  the  douche  was 
tried,  its  application  should  be  continued,  and  perseverance  will  often  be 
rewarded  by  success. 

Dr.  Sayre,  and  more  recently  Dr.  Broadbent,  have  drawn  attention  to 
the  use  of  the  cold  douche  to  induce  sleep  in  delirium  tremens,  and  in  the 
pyrexia  after  childbirth,  and  probably  in  febrile  diseases  generally.  A 
large  sponge  soaked  with  cold  water,  iced  if  possible,  is  dashed  against  the 
head,  face,  and  chest  several  times.  The  skin  is  then  rubbed  dry  with  a 
rough  towel,  and  sleep  follows  in  some  instances  almost  immediately.  If 
the  sleep  is  too  brief  repeat  the  application.  In  deirium  tremens  I  have 
often  seen  similar  good  results  follow  the  application  of  the  general  cold 
pack,  and  when  the  sleep  was  short  I  have  repeated  the  pack  hourly  for 
several  hours,  each  repetition  inducing  refreshing  sleep. 

Probably  this  treatment  by  dilating  the  cutaneous  vessels  withdraws 
blood  from  the  brain  and  so  produces  sleep. 

Many  cases  of  furious  maniacal  delirium  may  be  quieted  by  the  cold 
douche.  It  must  be  borne  in  mind  that  the  douche  is  a  powerful  remedy, 
Avhich  makes  it  necessary  to  carefully  watch  its  effect  on  the  patient's 
strength.  To  obviate  excessive  depression,  it  is  an  excellent  method  to 
place  the  patient  in  a  warm  bath,  and  to  apply  cold  to  the  head  in  the 
manner  just  described. 

Severe  pain  in  the  head,  met  with  in  acute  specific  fevers,  or  resulting 
from  gastric  disturbance,  may  be  relieved  very  gratefully  and  effectually 
in  the  way  recommended  by  Dr.  Hughes  Bennett:  "A  washhand-basin 
should  be  placed  under  the  ear,  and  the  head  allowed  to  fall  over  the  ves- 
sel, by  bending  the  neck  over  the  edge;  then  a  stream  of  cold  water  should 
be  poured  from  an  ewer  gently  over  tlie  forehead,  and  so  directed  that  it 
may  be  collected  in  the  basin.  It  should  be  continued  as  long  as  agreea- 
ble, and  be  repeated  frequently.  The  hair,  if  long,  should  be  allowed  to 
fall  into  the  cold  water,  and  to  draw  it  up  by  capillary  attraction."  The 
ice-bag  may  be  conveniently  substituted  for  this  application,  or  Thornton's 
cap,  composed  of  two  rolls  of  india-rubber  tubing,  through  Avhich  iced  cold 
water  is  made  to  flow.  This  application  greatly  relieves  headache  and 
lessens  or  even  prevents  delirium  and  favors  sleep.  Dr.  Hughes  Bennett 
agrees  with  Graves,  that  in  some  cases  very  hot  water  acts  even  more  effi- 
.  ciently  than  cold. 

The  cold  douche  is  also  an  excellent  local  tonic  to  individual  parts  of 
the  body.  It  may  be  employed  to  remove  that  stiffness  in  joints  remain- 
ing after  slight  injuries,  or  resulting  from  rheumatism  or  gout,  and  salt 
may  advantageously  be  added  to  the  water.  The  force  of  the  douche's 
impact  on  the  affected  part,  with  the  duration  of  its  application,  must  be 
regulated  by  the  condition  of  the  tissues.     If  very  weak,  it  is  better  at  first 


58  THE    TURKISH    r>ATII. 

to  play  the  water  in  tlie  noigliborhood  of  the  injured  or  weakened  joint. 
It  is  also  useful  in  chronically  inflamed  and  swollen  joints.  In  the  early 
stages,  especially  when  tenderness  persists,  it  is  useful  to  immerse  the  part 
in  hot  water  for  twenty  to  thirty  minutes,  and  immediately  on  removing- 
the  joint  to  cold  douche  it  either  in  a  single  stream  or  through  a  rose  for 
one  to  two  minutes,  well  rubbing  the  joint  afterward  till  it  glows.  Dr. 
Fuller  recomAiends  the  cold  douche  to  be  played  for  one  or  two  minutes 
upon  joints  affected  with  rheumatic  arthritis;  or  the  water  may  be  slightly 
warmed  in  winter,  and  then  the  parts  rubbed  till  they  are  Avarm  and  dry. 

Much  good  may  be  effected  in  spermatorrhoea  by  the  free  application 
of  cold  water  to  the  j^erinsum  and  buttocks  several  times  a  day,  and  by 
the  suspension  of  the  testicles  in  cold  water  for  a  few  minutes  night  and 
morning.  The  same  treatment  is  useful  in  varicocele.  A  cold-water  in- 
jection of  about  half  a  pint  every  morning  before  going  to  stool  relieves 
or  cures  piles  in  many  cases,  and  is  always  a  useful  addition  to  other  treat- 
ment; and  injections  of  cold  water  are  highly  recommended  in  chronic 
diarrhoea  and  chronic  dysentery.  The  cold  anal  douche  is  very  useful  in 
pruritis  ani,  as  well  as  for  piles.  Many  persons,  especially  women,  are 
troubled  with  cold  feet,  particularly  at  night;  so  cold,  indeed,  as  to  effec- 
tually prevent  sleep  for  hours.  This  condition,  which  may  rank  as  a 
distinct  ailment,  is  best  treated  by  immersing  the  feet  nightly  for  a  few 
minutes  in  cold  water,  rubbing  them,  whilst  in  the  foot-bath,  diligently 
until  they  become  warm  and  glowing,  and  then,  after  thorough  drying, 
clothinsf  them  in  thick  over-large  woolen  or  "fleecy  hosiery"  socks. 

A  cold  or  tepid  sitz-bath  is  a  very  useful  api^lication.  At  first  it 
contracts  the  vessels  of  the  cooled  skih,  also  the  intestinal  vessels,  and 
increases  the  blood  in  the  upper  part  of  the  body,  causing  even  a  rise  of 
temperature  in  the  axilla.  Subsequently,  and  especially  if  followed  by 
vigorous  friction  with  a  rough  towel,  the  constricted  vessels  become 
dilated,  and  the  abdominal  circulation  is  increased  and  gives  tone  to  the 
abdominal  organs,  and  so  relieves  constipation  and  strengthens  the  bladder. 

I  have  often  used,  with  advantage,  a  sitz-bath  for  ten  minutes  of  a 
temperature  between  70°  and  80°  Fah.,  for  overworked  patients  who 
return  from  business  tired,  restless,  and  irritable.  They  should  take  the 
bath  about  half  an  hour  to  an  hour  before  a  late  dinner.  It  removes 
restlessness  and  invigorates  and  favors  sleep. 

For  the  troubles  occurring  at  the  change  of  life  or  in  women  weakened 
by  excessive  menstruation,  I  often  obtain  considerable  benefit  by  sponging 
the  spine  with  equal  parts  of  white  vinegar  and  spirits  of  wine,  night  and 
morning,  for  five  to  ten  minutes.  Or  by  spongnig  the  spine  first  with 
water  as  hot  as  can  be  borne,  and  then  for  a  few  seconds  with  a  sponge 
wrung  out  of  cold  water.  The  first  application  is  the  most  successful.  It 
invigorates  and  soothes  irritable  nerves  and  prevents  the  fidgets.  The 
same  applications  often  relieve  "  cold  feet." 


THE   TURKISH   BATH. 

This  bracing  and  depurating  bath  combines  many  of  the  properties 
of  the  hot  and  cold  bath.  The  body,  subjected  to  great  heat,  is  made  to 
perspire  copiously.  If  the  bath  ended  here,  more  or  less  weakness  would 
ensue;  but  at  this  stage  the  free  application  of  cold  water  stimulates  and 


THE    TURKISH    BATH.  59 

braces  the  body,  and  produces  the  tonic  effects  of  the  cold  bath.  At  each 
stage  of  the  process,  the  Turkisli  bath  cleanses  the  system;  the  perspira- 
tion carrying  off,  and  the  cold  consuming,'  by  increased  oxydation,  effete 
and  noxious  substances  in  the  blood. 

The  Turkish  bath,  like  sea-air  and  sea-bathing,  is  a  true  tonic.  By  a 
tonic,  I  understand,  any  means  which  will  increase  both  the  destruction 
and  the  construction  of  tissue,  provided  the  constructive  remains  in  excess 
of  the  destructive  process,  and  by  promoting  the  nutrition  of  the  muscular, 
nervous,  and  other  systems,  tonics  increase  the  potential  force  of  the 
bodily  organs;  in  other  words,  tonics  increase  the  capacity  for  function. 
By  increasing  tissue  change,  tonics  promote  appetite  and  digestion  (see 
Cold). 

The  baths,  says  Dr.  Goolden,  are  useful  in  gout,  rheumatism,  sciatica, 
Bright's  disease,  eczema,  and  psoriasis;  they  benefit  bronchitis,  the  cough 
of  phthisis,  the  aching  of  muscles  from  unusual  exertion,  pains  in  the  seat 
of  old  wounds,  colds  in  the  head,  quinsies,  and  common  winter  coughs. 

It  is  not  amiss  here  to  caution  persons  prone  to  colds,  that  the  habit  of 
over-clothing  increases  this  liability.  This  cold-catching  tendency  may 
be  obviated  by  using  a  moderate  amount  of  clothing,  taking  a  cold  sponge- 
bath  every  morning,  and  occasional  wet-sheet  packing,  or  the  Turkish  bath 
once  or  twice  a  week. 

On  catching  cold,  a  patient  Avith  lungs  previously  healthy  becomes 
troubled  for  some  time  with  chronic  catarrh,  accompanied  by  considerable 
expectoration  and  some  shortness  and  oppression  of  breathing.  In  such  a 
case,  the  Turkish  bath  generally  affords  prompt  and  great  relief/  checking 
the  expectoration  and  easing  the  breathing.  In  bronchial  asthma  and  em- 
physematous asthma,  a  course  of  Turkish  baths,  say  one  every  second  or 
third  day,  is  very  useful;  this  subdues  chronic  bronchitis  and  renders  the 
patient  less  liable  to  catch  cold.  A  large  chamois  leather  waistcoat  reaching 
low  down  the  body  and  arms,  and  worn  over  the  flannel,  affords  great  relief 
in  bronchial  asthma  and  emphysematous  bronchitis.  This  jacket  is  ex- 
tremely warm,  and  protects  the  chest  against  the  vicissitudes  of  weather. 
It  is  a  nasty  practice  to  wear  it  next  the  skin. 

At  the  commencement  of  a  feverish  cold,  a  Turkish  bath  will  cut  the 
attack  short,  remove  the  aching  pains,  and  relieve  or  cure  the  hoarseness 
at  once.  The  bath  will  still  prove  very  useful  for  a  cold  of  several  days' 
standing,  though  its  good  effects  are  less  striking.  The  Turkish  bath  will 
relieve  or  carry  off  the  remains  of  a  general  severe  cold,  as  hoarseness, 
cough  with  expectoration,  and  lassitude.  Whilst  in  the  hot  chamber  the 
voice  generally  becomes  quite  clear  and  natural,  though  the  hoarseness 
may  afterward  return  in  a  slight  degree;  but  it  usually  continues  to  im- 
prove, becoming  natural  in  a  day  or  two,  a  repetition  of  the  bath  aiding 
complete  recovery.  In  more  obstinate  cases  several  baths  may  be  re- 
quired. Great  improvement  of  the  voice  in  the  hot  chamber  may  be 
taken  as  a  proof  that  the  bath  will  benefit,  even  though,  after  the  bath, 
the  hoarseness  returns  to  a  great  extent. 

The  Turkish  bath  is  serviceable  to  persons  who  after  dining  out,  not 
wisely  but  too  well,  suffer  next  day  from  malaise  and  slight  indigestion. 
A  course  of  Turkish  baths  is  very  beneficial  to  town-dwellers  leading  a 
sedentary  life,  Avho,  especially  if  they  live  freely,  are  apt  to  become  stout 
with  soft  and  flabby  tissues,  are  easily  tired,  suffer  from  lack  of  energy 
and  some  mental  depression.  Under  the  influence  of  the  bath,  their  mus- 
cles become  firmer,  the  fatness  decreases,  and  they  acquire  more  spirit  and 
energy. 


60  THE   TURKISH    HATH. 

A  course  of  Turkish  hatlis  is  useful  to  patients  whose  health  has  broken 
down  Ijy  residence  in  a  tropical  climate,  who  suffer  from  general  debility, 
enfceblement  of  mind,  dull  aching  pains  in  the  head,  and  broken  sleep. 
I  have  heard  the  Turkish  bath,  even  its  daily  use,  recommended  highly 
for  convalescents  from  acute  diseases,  to  promote  assimilation,  digestion, 
and  appetite.  Patients  suffering  from  jaundice,  acquired  in  a  tropical 
climate,  or  from  malaria,  have  often  testified  to  the  beneficial  effects  of 
Turkish  baths;  but  it  is  necessary,  as  indeed  it  is  with  all  persons  with 
shattered  health,  to  caution  them  against  the  too  vigorous  and  unre- 
strained use  of  the  bath.  The  patient  should  leave  tlie  hot  chamber  as 
soon  as  free  perspiration  occurs,  and  should  not  plunge  into  the  cold  bath, 
but  take  a  douche  with  slightly  tepid  water,  especially  i]i  cold  weather. 

]\Iany  dread  the  Turkish  bath  lest  they  should  catch  a  cold,  and  one 
often  hears  complaints  of  a  cold  coming  on  after  a  bath.  So  far  from 
tending  to  give  cold,  these  baths,  as  we  have  said,  obviate  the  tendency 
to  catarrh,  and  fortify  delicate  persons  against  a  cold-catching  tendency. 
If  ever  the  bath  is  answerable  for  a  cold,  it  is  almost  always  owing  to  the 
bather  leaving  the  bath-house  too  soon,  perhaps  in  inclement  weather, 
whilst  his  skin  is  still  perspiring  freely,  or  his  hair  is  soaking  wet. 

Again,  it  is  not  unusual  to  hear  complaints  that  the  bath  has  induced 
considerable  depression,  or  even  exhaustion,  lasting  perhaps  several  days; 
but  here  again  the  fault  rests  with  the  bather.  The  bath  must  be  adapted 
to  the  strength  of  the  patient,  and  it  is  always  prudent  to  take  the  first 
bath  circumspectly,  the  bather  not  staying  too  long  in  the  hot  chamber, 
and  undergoing  the  bracing  application  only  n  few  seconds,  with  water 
not  very  cold.  It  is  difficult  to  point  out  the  precise  time  a  bather  ought 
to  remain  in  the  hot  chamber.  If  delicate,  and  it  is  his  first  bath,  he 
should  not  enter  a  chamber  hotter  than  130°  to  140°  Fah.,  and  should 
stay  there  only  twenty  minutes  or  half  an  hour,  or  less,  should  he  feel 
faint  or  tired.  The  patient's  sensations  are  the  best  guide;  sometimes, 
especially  if  suffering  from  pain,  the  bath  soothes  and  eases,  and  then  he 
can  remain  in  the  hot  chamber  an  hour,  the  first  bath;  but,  I  repeat,  he 
should  at  once  leave  when  he  feels  faint  or  tired.  At  first,  the  patient, 
not  seldom,  on  commencing  the  bath,  fails  to  perspire;  in  this  case,  he 
should  be  removed  from  the  chamber  in  ten  minutes,  have  warm  Avater 
poured  over  him,  and  be  well  shampooed,  and,  unless  he  is  tired  and  faint, 
should  then  return  to  the  hot  chamber.  It  is  a  rule  in  these  establish- 
ments to  advise  even  an  old  bather  not  to  enter  the  hotter  chamber  of  180° 
to  220°  Fall.,  till  the  skin  has  become  moist  with  perspiration;  though 
many  disregard  this  injunction  with  apparent  impunity.  Even  if  the  first 
bath  causes  some  depression,  this  need  not  happen  afterward,  partly  be- 
cause the  bather  will  have  become  accustomed  to  the  process,  and  partly 
because  he  will  know  how  to  adapt  it  to  his  strength.  Yet  it  must  be  ad- 
mitted that  some  persons,  even  with  every  precaution,  cannot  take  a  Turk- 
ish bath  without  experiencing  much  depression. 

Acute  rheumatism  and  acute  gout  have  been  treated  with  these  baths; 
but,  as  in  most  instances,  the  severity  of  the  pain  renders  it  impracticable 
to  take  patients  thus  affected  to  a  Turkish  bath,  a  modified  substitute  for 
it,  shortly  to  be  described,  may  be  taken  at  home.  The  acute  j)ain  of 
gout,  it  is  said,  disappears  in  the  hot  chamber,  to  return  soon  afterward 
in  a  diminished  degree. 

The  Turkish  bath  is  particularly  valuable  in  subacute  and  chronic 
gout,  but,  as  might  be  expected,  it  is  not  in  all  cases  equally  serviceable. 


THE   TURKISH    HATH.  61 

In  long-standing  cases  in  whicli  the  attacks  have  occurred  so  frequently 
as  to  distort  the  joints  by  deposits,  and  patients  are,  perhaps,  liable  to 
repeated  relapses,  and  are  scarcely  ever  free  from  pain,  the  efficacy  of  the 
bath,  though  striking,  is  less  apparent  than  in  milder  and  more  tractable 
forms;  yet  even  in  these  severe  cases,  the  bath  affords  considerable  relief 
by  diminishing  the  frequency  and  severity  of  the  relapses,  and  by  remov- 
ing the  pervading  sensation  of  invalidism.  The  Turkish  bath  is,  perhaps, 
more  efficacious  than  other  remedies  in  a  case  of  the  following  kind: — A 
patient  inclined  to  stoutness  complains  of  slight  and  fugitive  pains;  the 
joints,  but  little  swollen,  are  merely  stiff  and  a  little  red  and  hot.  The 
gout  affects  many  parts  often  in  succession — the  joints,  the  head,  the  back, 
and  perhaps  some  of  the  internal  organs,  as  the  bladder,  etc.  During 
an  attack  tiie  patient  complains  of  malaise,  and  his  complexion  often  be- 
comes dullish.  The  tissues  are  often  soft  and  flabby,  and,  in  spite  of  judi- 
cious diet  and  abundant  exercise,  the  patient  may  be  seldom  free  from 
some  evidence  of  gout,  sufficient  to  annoy  but  not  to  disable  him  for  work. 
After  one  or  two  baths  the  pains,  the  swelling,  and  the  malaiae  disappear, 
the  joints  become  supple,  and  after  a  time,  the  baths  being  continued, 
the  complexion  loses  its  sallowness,  the  tissues  become  firm,  and  the  undue 
stoutness  undergoes  diminution.  On  discontinuing  the  baths,  the  gouty 
symptoms  will  often  recur,  again  to  disappear  on  the  resumption  of  the 
treatment.  A  gouty  patient  may  advantageously  supplement  the  action 
of  the  Turkish  bath  by  drinking  certain  suitable  natural  mineral  .waters. 

The  Turkish  bath  is  useful  in  the  various  kinds  of  chronic  rheuma- 
tism. 

A  patient  who,  in  damp  weather,  or  during  an  east  or  north-east  wind, 
suffers  from  stiffness  and  pains  in  several  joints,  will  derive  much  benefit 
from  a  Turkisli  bath.  The  shoulder  joint  is  often  affected,  the  pain  and 
tenderness  being  frequently  limited  to  a  small  spot. 

Again,  a  patient  without  any  previous  history  of  rheumatism  finds  his 
shoulder  set  fast,  is  unable  to  move  it,  except  to  a  limited  extent,  without 
great  pain.  Here,  again,  the  pain  and  tenderness  may  be  very  circum- 
scribed. In  such  a  case  a  Turkish  bath  generally  affords  great  relief. 
Galvanism  too,  even  one  application,  will  often  entirely  remove  or  greatly 
lessen  the  pains  and  stitt'ness.  Again,  the  Turkish  bath  gives  much  relief 
in  mild  and  chronic  rheumatoid  arthritis,  and  often  retards  the  march  of 
this  disease.     The  bath  often  relieves  lumbago. 

Mr.  Milton  finds  the  bath  useful  in  allaying  the  tormenting  itching  of 
prurigo  unconnected  with  lice. 

Should  it  happen  that  the  regular  Turkish  bath  is  not  available,  then 
one  or  other  of  the  following  modifications  of  it  may  be  substituted: — The 
patient,  quite  naked,  seated  on  a  wicker  chair,  with  his  feet  on  a  low  stool, 
is  enveloped  in  two  or  three  blankets,  the  head  alone  being  exposed,  and 
a  spirit  lamp  with  a  large  wick  is  placed  under  the  chair.  In  about  a 
quarter  of  an  hour  perspiration  streams  down  the  body,  and  tiiis  secretion 
may  be  increased  by  drinking  plentifully  of  water,  and  by  placing  a  pan 
of  water  over  the  lamp.  When  the  patient  has  perspired  sufficiently  the 
blankets  are  quickly  removed,  and  one  or  two  pailfuls  of  cold  water  are 
poured  over  him;  or,  if  this  affusion  is  too  heroic,  he  may  step  into  a 
general  bath  at  80°,  or,  better  still,  a  few  degrees  lower.  Dr.  Taylor,  of 
Nottingham,  finds  this  treatment  useful  in  obstinate  skin  affections,  rheu- 
matism, catarrh,  syphilis,  and  in  reducing  stoutness  arising  from  an  inac- 
tive life.     The  instrument  makers  now  supply  convenient  forms  of  the 


62  POULTICES    AND*  FOMENTATIONS. 

domestic  Turkish  bath.  It  is  far  better,  however,  when  practicable,  to  em- 
ploy the  Turkish  bath  itself. 

Dr.  Nevin  highly  recommends  the  following  handy  steam-bath  in  the 
treatment  of  acute  rheumatism,  available  when  tlie  patient  is  lying  help- 
less and  irremovable  in  bed: — A  couple  of  common  red  bricks  are  placed 
in  an  oven  hot  enough  for  baking  bread,  and  in  half  an  hour  or  a  little 
more,  they  are  sufficiently  heated  for  the  purpose.  The  patient's  body 
linen  having  been  previously  removed,  these  two  bricks  are  folded  in  a  piece 
of  common  thick  flannel,  thoroughly  soaked  in  vinegar,  and  laid  on  two 
plates;  one  is  to  be  placed  about  a  foot  distant  from  one  shoulder,  and  the 
other  about  equally  distant  from  the  opposite  leg,  and  the  bed-cloth(,'s  are 
then  to  cover  the  bricks  and  the  patient  closely  round  the  neck.  A  most 
refreshing  acid  steam-bath  is  thus  obtained;  and  tiie  supply  of  steam  may 
be  kept  up,  if  necessary,  by  remonng  one  brick  and  replacing  it  by  an- 
other hot  one  kept  in  reserve.  When  the  patient  has  been  in  the  bath  for 
fifteen  or  twenty  minutes,  the  bed-clothes  and  plates  should  be  removed, 
and  the  patient  instanthi  mopped  all  over,  eery  rapidhi,  with  a.  towel  wrung 
out  in  cold  water,  and  then  quickly  rubbed  dry.  Dry  warm  linen  must 
be  put  on  at  once,  and  dry  bed-clothes  must  replace  those  which  Avere  on 
the  Ijed  previously.  The  under-sheet  can  be  removed,  and  a  dry  one  sub- 
stituted by  fastening  the  corners  of  the  dry  sheet  to  those  of  the  damp 
one;  generally  very  little  difficulty  is  met  with  in  simply  drawing  the  old 
sheet  from  under  the  patient,  when  the  dry  one  follows  it,  and  is  left  in 
its  place.  The  patient  ordinarily  experiences  great  and  speedy  relief  from 
this  bath.  The  exhausting  sweats  are  usually  diminished,  and  the  neces- 
sity of  opium  much  lessened.  The  change  of  the  body  linen  can  be  easily 
accomplished  by  tearing  the  night-shirt  open  from  top  to  bottom  down 
the  back.  The  steam-bath  and  subsequent  cold  douche  should  be  con- 
tinued after  the  patient  is  able  to  walk  about,  as  they  contribute  to  the 
healthy  action  of  the  skin  and  promote  free  mobility  of  the  joints.  After 
the  patient  is  able  to  get  out  of  bed,  the  bath  may  be  administered  in  the 
manner  previously  described.  The  steam-bath,  according  to  Dr.  Sieve- 
king,  relieves  the  pain  and  checks  the  perspiration  in  acute  rheumatism  to 
a  degree  he  has  failed  to  attain  by  any  other  treatment. 

Or  the  following  method  may  be  used  as  in  some  degree  a  substitute 
for  a  Turkish  bath.  After  a  general  hot  bath  sponge  all  over  with  tepid 
or  cold  water;  or  sponge  the  whole  body  first  with  hot  water  and  then 
for  a  short  time  with  cold  water. 

Some  persons  cannot  stand  the  usual  morning  cold  tub  can  substitute 
these  methods  with  much  benefit,  and  obtain  the  tonic  invigorating  effects 
which  follow  the  morning  flat  sponge-bath. 


POULTICES  AND  FOMENTATIOXS. 

Poultices  and  fomentations,  in  such  common  use,  are  simply  local 
baths  applied  to  the  skin.  When  its  surface,  or  the  structures  beneath  it 
are  inflamed,  poultices  and  fomentations  are  a  convenient  and  efficacious 
means  of  utilizing  warmth  and  moisture  in  the  treatment  of  diseased 
parts.  The  warmth  and  moisture  relax  the  vessels,  and  increase  the 
collateral    circulation,    and   in   some   degree   abate   the   tension   due  to 


POULTICES    AND    FOMENTATIONS.  63 

inflammation,  and  so  relieve  pain.  Applied  at  the  very  beginning  to 
inflamed  tissues,  to  abscesses,  inflamed  pimples,  and  the  like,  poultices 
often  summarily  check  the  inflammation,  and  prevent  the  formation  of 
pus.  Fomentations  with  water  as  hot  as  can  be  endured  also  arrest 
inflammation  and  check  the  formation  of  matter,  and  should  be  gen- 
erally employed  as  adjuncts  to  poultices.  Hot  fomentations  will  often 
disperse  or  restrict  the  development  of  acne  indurata,  herpes  labialis,  and 
similar  inflamed  jjimples  apt  to  appear  on  the  face. 

These  applications  are  of  further  use  when  suppuration  has  set  in  and 
matter  requires  to  be  expelled.  Poultices  greatly  facilitate  the  passage 
of  the  matter  to  the  surface  and  further  its  expulsion,  while,  at  the  same 
time,  they  limit  considerably  the  spread  of  inflammation  in  all  directions. 
Here,  again,  very  hot  fomentations,  often  repeated,  continued  for  some 
time,  are  a  useful  supplement  to  poultices. 

It  should  be  remembered  that  much  depends  on  the  heat  of  the  appli- 
cation. Poultices  should  be  always  applied  as  hot  as  they  can  be  borne,  and 
should  be  frequently  changed,  lest  they  become  cold  and  hard.  Indeed,  they 
can  scarcely  be  changed  too  often;  in  hospital  practice  it  is  difficult  to  con- 
stantly renew  poultices;  yet  even  in  such  institutions,  where  the  supply 
of  nurses  is  limited,  poultices  should  be  changed  at  least  every  two  or  three 
hours. 

Where  applied  to  disperse  inflammation,  or  to  hasten  the  maturation 
of  abscesses,  the  poultices  should  be  large,  reaching  beyond  the  limit  of 
the  inflamed  tissues;  but  as  soon  as  the  abscess  or  boil  has  matured  and 
burst,  the  poultice  should  be  very  little  larger  than  the  opening  in  the 
skin  through  which  the  matter  escapes.  A  large  poultice,  applied  over- 
long,  soddens  and  irritates  the  skin,  and  is  liable  to  produce  an  eruption 
of  eczema,  or  to  develop  fresh  boils  around  the  base  of  the  original  one. 

Open  sores,  like  discharging  abscesses,  or  sloughing  sores  or  ulcers, 
are  best  treated  with  lint  soaked  in  a  saturated  solution  of  boracic  acid, 
or  some  other  antiseptic  agent,  to  destroy  germs,  and  so  prevent  sup- 
puration and  further  destruction  of  tissue.  The  boracic  application  is 
useful  in  the  inflamed  stage  of  eczema. 

In  the  treatment  of  boils,  carbuncles,  abscesses,  and  inflamed  lym- 
phatics, it  is  an  excellent  plan  to  smear  over  the  inflamed  tissues  a  com- 
j)ound  of  equal  parts  of  extract  of  belladonna  and  glycerine,  and  on  this 
dressing  to  superimpose  a  poultice.  The  belladonna  eases  pain  and  re- 
duces inflammation.     (See  Sulphides.) 

In  order  to  protect  the  adjacent  tissues  from  the  undue  action  of  the 
poultice,  so  as  to  check  the  production  of  fresh  boils,  it  is  a  good  plan  to 
place  over  the  boil  a  piece  of  opium  plaster  with  a  circular  hole,  and  to 
apply  the  poultice  only  over  the  plaster.  Another  jjrotective  plan  is 
to  smear  the  contiguous  surface  with  zinc  ointment. 

Poultices  moderate  the  inflammation  and  alleviate  the  pain  in  skin  dis- 
eases, as  eczema,  etc.,  when  the  skin  is  inflamed,  painful,  red,  and  swollen. 

Poultices  are  not  only  soothing  when  in  direct  contact  with  inflamed 
tissues,  but  they  appear  to  act  in  the  same  manner  on  deep-seated  parts. 
Large  poultices  applied  very  hot,  and  removed  as  soon  as  they  become 
cool,  are  of  great  service  in  pneumonia,  pleurisy,  bronchitis,  pericarditis, 
peritonitis,  etc.  To  avoid  exposure  of  the  warm  moist  skin,  the  old  poul- 
tice should  not  be  removed  till  the  new  one  is  ready  to  replace  it. 

These  applications  are  extremely  useful  to  children  attacked  with 
bronchitis,  broncho-pneumonia,  or  lobular  pneumonia.  As  young  chil- 
dren are  apt  to  be  restless,  and  to  toss  about  in  bed,  the  entire  chest 


64  POULTICES   AND    FO. "MENTATIONS. 

should  1)0  cnvolopod  in  a  jacket-poultice.  The  ordinary  poultice  soon  be- 
comes rucked  up,  and  converted  into  a  narrow  band  encircling  only  a  very 
limited  portion  of  the  chest,  whilst  the  uncovered  part  of  the  chest  is  ex- 
posed to  cold.  The  jacket-poultice  should  be  constructed  with  a  piece 
of  linen  sufficiently  large  to  go  quite  round  the  chest,  and  tapes  should 
be  sewn  to  it  in  such  a  manner  that  they  can  be  tied  in  front,  and  over 
each  shoulder.  It  is  as  well  to  have  three  pairs  of  tapes,  so  as  to  admit  of 
three  fastenings  down  the  front  of  the  chest. 

A  poultice,  to  retain  its  heat,  should  be  spread  an  inch  or  more  thick, 
or  it  may  be  made  thinner,  and  externally  coated  with  a  layer  of  cotton- 
wool. The  cotton-wool  being  light,  does  not  hamper  the  breathing — a 
matter  of  importance,  especially  with  children. 

In  inflammation  of  deep-seated  organs  the  same  methods,  modified  to 
suit  the  part,  should  be  adopted.  In  peritonitis  it  is  of  great  importance 
to  spread  the  poultice  thin  and  cover  it  with  a  layer  of  cotton- wool;  if 
heavy  it  aggravates  the  pain. 

Poultices  are  useful  in  acute  rheumatism,  lumbago,  sciatica,  pleuro- 
djTiia,  myalgia,  and  in  those  so-called  rheumatic  pains  which  often  attack 
limited  parts  of  the  body,  as  one  arm,  etc'  They  are  soothing  and 
pleasant  to  the  inflamed  joints  in  rheumatic  fever,  although  cotton- wool  is 
often  preferred.  In  acute  lumbago,  poulticing  often  brings  speedy  relief, 
the  severest  cases  being  greatly  benefited  in  a  few  hours,  and  generally 
cured  in  one  or  two  days.  The  poultice  must  be  very  hot,  and  large 
enough  to  cover  the  whole  loins  or  part  affected,  and  thick  enough  to 
remain  quite  hot  for  half  an  hour,  when  it  must  be  changed.  If  the  pain 
is  persistent  this  treatment  shmild  ])e  continued  for  three  hours,  or  longer; 
the  skin  must  then  be  covered  with  a  piece  of  flannel,  and  the  flannel 
covered  with  oil-silk;  this  after-treatment  promotes,  what  is  most  desir- 
able, free  perspiration. 

When  electricity,  the  needle,  or  poultices,  fail  to  give  more  than 
slight  temporary  relief,  it  will  often  be  found  that  the  lumbago  is  accom- 
panied with  high  fever,  being  sometimes  the  first  symptom  of  an  attack 
of  rheumatic  fever. 

Sciatica  may  be  treated  in  the  same  way,  but  the  result  is  not  often 
so  satisfactory.     (Vide  Ether.) 

Poultices  applied  in  the  same  way  as  for  lumbago,  and  followed  by 
the  application  of  lint  and  oilskin,  are  often  useful  in  severe  forms  of 
pleurodynia  and  myalgia.  Belladonna  liniment  is  usually  sufficient,  and 
even  to  be  preferred  in  pleurodynia;  and  sometimes  ether  spray  at  once 
and  permanently  removes  the  pain  of  this  annoying  affection. 

As  we  have  said,  poultices  may  be  made  of  various  substances,  lin- 
seed meal,  oatmeal,  bread,  or  starch.  Each  has  its  peculiar  character. 
Linseed-meal  and  oatmeal  poultices  have  most  properties  in  com- 
mon; they  make  compact  and  only  slightly  porous  poultices,  retaining 
heat  and  moisture  longer  than  other  kinds,  and  are  consequently  often 
to  be  preferred  to  bread  or  starch.  Rut  linseed  contains  an  acrid 
matter,  wdiicli  sometimes  irritates,  especially  if  the  skin  is  of  a  fine 
and  delicate  texture,  or  if  it  is  inflamed  by  some  eruption,  in  which  case 

'  Galvanism  is  highly  useful  in  some  forms  of  these  complaints,  especially  in  lum- 
bago. In  sciatica  it  gives  at  least  temporary  relief,  and  in  some  cases  a  few  applications 
effect  a  curg.  Sciatica  and  deep-seated  pains  about  tlie  shafts  of  the  long  bones,  even  the 
dull  aching  pain  in  the  joints,  which  not  unfrequently  remams  after  an  attack  of  acute 
rheumatism,  will  often  yield  to  galvanism. 


POULTICES    AND    FOMENTATIONS.  65 

oatmeal  or  bread  must  lie  siibstitiited.  Bread  poultices  are  more  porous 
and  blander  than  those  of  linseed-meal,  but  the  porosity  depends  very 
greatly  on  the  way  of  making  them.  Bread  poultices  cool  more  quickly 
and  give  less  moisture  to  the  skin,  than  those  made  of  linseed-meal. 
Starch  poultices  retain  their  heat  for  a  considerable  time,  and  are  very 
^land,  unirritating  applications. 

It  is  as  well  to  mention  that  linseed -meal  poultices  are  more  tenacious 
than  those  made  of  bread,  and  are  therefore  less  liable  to  break  up  and 
fall  about  the  bed  and  clothes  of  the  patient,  rendering  him  uncomfort- 
able. 

In  making  a  poultice,  care  should  be  taken  that  the  water  boils,  and 
that  all  the  materials,  linseed-meal,  linen,  strappings,  bandages  or  tapes, 
wool  and  oil-silk,  are  close  at  hand  ready  for  use,  and  placed  before  a  good 
fire  to  be  thoroughly  w^armed.  To  manufacture  a  linseed  poidtice,  suffi- 
cient boiling  water  should  be  poured  into  a  heated  bowl,  and  the  meal 
must  be  quickly  sprinkled  into  the  bowl  with  one  hand,  while  with  the 
other  the  mixture  must  be  constantly  stirred  Avitli  a  knife  or  spatula,  till 
sufficient  meal  has  been  added  to  make  a  thin  and  smooth  dough.  The 
mixture  should  be  compounded  as  rapidly  as  possible,  otherwise  the  poul- 
tice when  made  will  be  almost  cold.  Only  an  experienced  hand  can  make 
a  model  poultice.  By  adding  the  meal  to  the  water,  with  constant  stir- 
ring, instead  of  the  water  to  the  meal,  a  thorough  blending  of  the  two  in- 
gredients is  ensured,  not  a  knotty,  lumpy,  uncomfortable  mass,  too  often 
vexing  instead  of  soothing  the  patient.  The  dough  must  then  be  spread 
quickly  and  evenly  on  the  warm  linen,  already  cut  of  proper  size  and  shape, 
the  edges  of  the  linen  turned  a  little  way  over  the  meal  to  prevent  any 
portion  escaping  beyond  the  linen,  and  to  protect  the  patient's  clothes. 

There  are  two  methods  of  making  bread  jioultices.  One  way  is  to  cut 
the  bread  in  thickish  slices,  put  it  into  a  basin,  pour  boiling  water  over 
it,  and  place  the  soaking  mass  by  the  fire  for  five  minutes;  then  pour  ofE 
the  w^ater,  add  fresh  boiling  w^ater,  and  place  by  the  fire;  afterwards 
draining  the  bread,  beat  up  with  A  fork,  and  spread  the  poultice.  The 
other  plan  is  to  cut  stale  bread  into  thick  slices  into  a  saucepan  and  pour 
enough  boiling  water  over  it  to  cover  it;  place  the  whole  by  the  fire,  and 
allow  it  to  simmer  for  a  short  time,  then  strain  and  prepare  the  poul- 
tice. The  first  plan  makes  a  porous  poultice,  the  second  a  more  compact 
poultice,  sharing  the  character  of  linseed-meal.  As  w'e  shall  see,  each 
pojiltice  has  its  fitting  application. 

Bran  poultices  are  useful  on  account  of  their  lightness. 

Starch  poultices  are  entirely  unirritating,  and  retain  their  heat  for  a 
considera];)le  time.  The  way  to  proceed  is  to  add  a  little  cold  water  to  the 
starch,  and  to  blend  the  tw^o  into  a  pap;  then  add  sufficient  boiling  water 
to  make  a  poultice  of  the  required  consistence,  which  must  be  spread  on 
linen  in  the  manner  already  described.  Starch  poultices  soothe  open 
cancers,  and  allay  skin  eruptions,  when  there  is  much  inflammation,  heat, 
and  pain. 

There  are  several  ways  of  employing  charcoal  as  a  poultice.  It  is  used 
to  prevent  disagreeable  odors  from  foul  sores,  and  it  is  thought  also  to  pro- 
mote a  healthy  condition  of  the  tissues.  When  employed  for  this  double 
purpose,  charcoal  is  added  to  the  poultice.  As  a  porous  poultice  is  here 
reqiiired,  bread  is  better  for  the  purpose  than  linseed-meal.  A  portion  of 
the  charcoal  should  be  uniformly  mixed  wnth  the  bread,  but  the  greater 
part  should  be  sprinkled  over  the  surface  of  the  poultice.  It  is  doubtful 
5 


66  POULTICES    AND    FOMENTATIONS. 

wht'tlier  a  charcoal  poultice  is  greatly  superior  to  a  simple  bread  poiiltice; 
for  the  charcoal  must  soon  cease  to  absorb  gases,  and  thus  lose  its  deodoriz- 
ing property.  It  may,  perhaps,  promote  a  healthier  condition  in  the  sore. 
If  the  object  is  merely  to  prevent  disagreeable  smells  and  to  keep  the  air 
of  the  room  pure,  the  plan  pointed  out  in  the  section  on  charcoal  is  to  be 
preferred.  • 

It  is  a  good  practice  to  sprinkle  foul,  sloughing,  putrid  sores  with  dry 
charcoal,  and  over  the  charcoal  to  place  a  simple  poultice,  or  to  make  the 
poultice  of  well-toasted  or  of  burnt  bread.  This  treatment  apj)ears  to 
hasten  the  separation  of  the  sloughs,  and  to  promote  a  healthier  state  of 
the  tissues,  and  may  be  applied  to  a  boil  when  the  core  is  separating,  or  to 
a  bed-sore  while  the  black  slough  still  adheres  to  the  living  tissues. 

Some  maintain  that  a  yeast  poultice  is  useful  in  sloughing  sores,  and 
that  it  prevents  destruction  of  the  tissues,  and  promotes  the  separation 
of  sloughs.  Yeast  poultices  are  made  m  two  ways.  Yeast  and  water  may 
be  added  to  floiir  till  ordinary  dough  is  made,  and  the  dough  is  applied 
while  fermentation  is  going  on.  In  this  case  it  is  simply  an  application  of 
*'  rising  dough. ^'  The  other  way  is  to  smear  warm  yeast  over  the  surface 
of  a  simple  bread  poultice. 

A  carrot  poultice,  which  is  supposed  to  make  wounds  cleaner  and 
healthier,  is  made  by  boiling  carrots  till  they  become  quite  soft,  mashing 
them  with  a  fork,  and  spreading  the  pulp  on  the  linen  in  the  ordinary  way. 

To  sloughing  sores,  as  we  have  seen,  better  apply  some  efficient  anti- 
septic. They  should  be  washed  with  saturated  boracic  acid  solution,  or 
with  carbolic  acid  solution,  etc.,  and  then  covered  with  lint  or  cotton- 
wool soaked  in  one  or  other  of  these  solutions. 

Laudanum  is  sometimes  added  to  poultices  to  ease  pain;  and  it  is  es- 
pecially effectual  when  the  skin  is  broken. 

Solutions  of  chloride  of  lime  or  of  soda  may  be  added  to  poultices  to 
destroy  offensive  gases  given  off  from  unhealthy  sores. 

In  eczema,  with  much  inflammation  and  sensation  of  heat.  Dr.  McCall 
Anderson  recommends  a  cold  potato  poultice  sprinkled  with  a  small  quan- 
tity of  absorbent  powder,  containing  camphor.  The  powder,  a  useful 
dusting  powder  without  the  poultice,  is  composed  of  half  a  drachm  of 
camphor,  reduced  to  powder,  with  rectified  spirit  and  three  drachms  each 
of  powdered  talc  and  oxide  of  zinc. 

Professor  Marshall  employs  an  iodide  of  starch  poultice  to  clean  slough- 
ing sores.  A  jelly  is  made  with  two  ounces  of  starch  mixed  with  six 
ounces  of  boiling  water,  to  which  before  it  cools  should  be  added  half  an 
ounce  of  liquor  iodi.     The  mixture  is  spread  on  lint,  and  applied  cold. 

Fomentations  by  means  of  flannel  wrung  out  of  boiling  water  are  em- 
ployed for  similar  purposes  as  poultices.  They  are  used  for  the  sake  of 
their  moisture,  but  especially  for  their  warmth,  and  they  differ  from  poul- 
tices in  being  less  weighty,  and  therefore  less  likely  to  increase  the  pain 
of  very  tender  parts.  The  flannel  is  wrung  out  by  means  of  a  wringer 
made  of  stout  towelling  attached  to  two  rods.  The  boiling  wet  flannel  is 
placed  in  the  wringer,  which  is  then  twisted  round  the  flannel  very  strongly 
till  the  water  is  thoroughly  squeezed  oiit.  As  the  flannel  when  fi.rst  taken 
from  the  boiling  water  is  too  hot  to  be  held  in  the  hands,  the  wringer  is 
useful.  In  the  absence  of  a  wringer  an  ordinary  towel  will  ansv/er  fairly 
well.  Wrung  as  dry  as  possible,  these  fomentations  may  be  used  very  hot 
without  fear  of  scalding  or  blistering  the  skin.  The  fomentation  should 
be  covered  outside  with  a  piece  of  macintosh,  and  tied  on  with  bandages. 
As  hot  fomentations  quickly  cool,  and  being  chiefly  used  for  the  sake  of 


THE   MEDICINAL    USES    OF    ICE.  67 

lu'iit,  they  must  be  frequently  renewed:  when  finiilly  removed,  the  skin 
must  be  carefully  wiped  dry,  and  covered  with  flannel  or  cotton-wool  to 
prevent  catching  cold. 

Fomentations,  in  a  less  degree  poultices,  relax  spasm  in  the  internal 
organs,  as  in  intestinal,  renal  and  biliary  colic.  In  very  extensive  inflam- 
mation fomentations  are  preferable,  as  a  large  poultice  is  heavy  and  un- 
comfortable. Thus  fomentations  are  employed  when  a  limb  is  extensively 
affected  with  erysipelas,  or  when  the  tissues  have  been  widely  contused 
and  have  become  inflamed. 

Sponging  the  face  Avith  water  as  hot  as  can  be  borne  is  a  very  useful 
application  in  acne  indurata;  it  will  disperse  the  incipient  spots,  and  limit 
the  size  and  hasten  the  maturation  of  the  more  matured  ones,  and  at  the 
same  time  greatly  lessen  for  some  hours  the  redness  of  the  eruption. 

Twenty  or  thirty  drops  of  turpentine  sprinkled  on  a  hot  fomentation 
of  the  above  description  makes  a  good  counter-irritant,  useful  when  it  is 
needful  to  combine  a  stimulating  with  a  warm,  soothing  action. 

An  alkaline  poultice,  composed  of  nine  parts  of  linseed-meal  and  one 
part  of  bicarbonate  of  soda,  is  a  useful  application  in  gout. 

Sometimes  it  is  desirable  to  apply  heat  to  a  part  of  the  surface  of  the 
body,  when  at  the  same  time  it  is  important  to  avoid  relaxation  of  the 
tissues  which  moisture  Avould  produce.  In  such  cases  various  drv,  strongly 
heated  applications  are  used.  Flannel,  almost  scorched  before  the  fire, 
or  in  an  oven,  is  sometimes  employed,  but  it  speedily  loses  heat.  Sand  or 
chamomile  flowers  retain  heat  far  better;  they  may  be  strongly  heated 
over  the  fire  in  an  iron  pan,  and  then  be  run  into  a  heated  linen  bag 
made  for  the  purpose,  of  such  shape  and  construction  that  the  contents 
shall  form  a  thickish  and  even  layer.  Each  substance  |x»ssesses  its  re- 
spective advantages;  sand,  though  heavy,  retains  heat;  chamomile  flowers, 
though  light,  soon  lose  their  warmth.  A  tliin  piece  of  flat  tile  heated  in 
the  oven,  and  wrapped  in  flannel,  is  lighter  than  sand,  retains  its  heat  for 
a  considerable  time,  and  is  easily  procured.  These  apialications  are  of 
great  service  in  relieving  the  pain  of  spasms. 


THE  MEDICINAL  USES  OF  ICE. 

Ice  is  frequently  used  to  abstract  heat,  to  check  bleeding,  to  allay  inflam- 
mation, and  to  destroy  sensation.  Ice  broken  up  with  the  help  of  a  large 
needle  into  fragments  may  be  enclosed  in  a  bladder  or  thin  india-rubber 
bag,  flrst  squeezing  the  air  out  of  the  bag.  After  fllling  the  bag  about 
one  third  of  its  capacity,  its  mouth  should  be  tied  on  a  cork,  so  as  to 
afford  a  purchase  for  the  twine.  The  ice-bag  may  then  be  adapted  to 
almost  any  shape,  and  fitted  to  the  inequalities  of  the  body,  and,  if  re- 
C|uired,  may  be  fashioned  into  a  sort  of  cap  for  the  head. 

This  cap  is  applied  to  the  head  in  tubercular  and  simple  meningitis, 
and  may  be  employed  to  allay  the  severe  headache  of  the  early  stages  of 
acute  fevers.  Sometimes  the  ice-bag  laid  on  the  epigastrium  will  ease  the 
severe  pain  and  vomiting  of  chronic  ulcer,  or  of  cancer  of  the  stomach. 
It  may  be  applied  in  prurigo  of  the  vulvae;  other  treatment,  however,  is 
generally  to  be  preferred. 

In  typhlitis  and  typhoid  fever  an  ice  poultice  applied  over  the  right 
side  of  the  lower  part  of  the  abdomen  is  often  useful  in  relieving  inflam- 
mation and  pain. 


68  THE   MEDICINAL   USES    OF   ICE. 

A  lump  of  ice  inserted  into  the  uterus,  or  jiushed  into  the  rectum, 
IS  sometimes  used  to  arrest  uterine  hfemorrhage  after  delivery. 

Ice  is  used  internally  for  a  variety  of  purposes.  Sucking  ice  allays 
thirst,  and  is  very  grateful  to  fever  patients.  It  is  likewise  sucked  to 
check  bleeding  from  the  mouth  or  throat,  stomach  or  lungs.  To  check 
bleeding  from  the  stomach  small  jneces  should  be  swallowed. 

The  constant  sucking  of  ice  is  most  efficacious  in  combating  acute  in- 
flammation of  the  tonsils  or  throat ;  it  also  is  very  beneficial  in  the  sore 
throat  of  scarlet  fever,  and  other  acute  specific  throat  diseases,  and  even 
in  diphtheria.  It  often  proves  most  soothing,  allays  the  heat  and  pain, 
and  checks  the  abundant  secretion  of  mucus,  which  is  so  harassing  from 
the  constant  liaAvking  and  deglutition  it  occasions.  In  tonsillitis,  and 
indeed  in  all  inflammations  of  the  throat,  the  good  effects  of  ice, 
especially  when  used  at  the  very  beginning  of  the  attack,  are  most  marked. 
The  ice  should  be  sucked  as  constantly  as  possible,  and  be  continued  till 
the  disease  has  fairly  declined. 

In  the  same  way  ice  is  employed  to  allay  the  nausea,  sickness  and  pain 
of  disease  of  the  stomach. 

Ice  may  be  applied  to  an  inflamed  and  prolapsed  rectum  or  uterus,  to 
reduce  inflammation  and  swelling,  so  as  to  enable  these  parts  to  be  re- 
turned to  their  proper  place. 

8ome  apply  ice  to  the  head  in  delirium  tremens  and  in  the  convulsions 
of  children. 

The  application  of  a  small  bladder  or  india-rubber  bag  of  ice  will  dull 
or  even  neutralize  pain  from  inflamed  piles,  or  after  an  operation  for  piles 
or  fissure  of  the  anus. 

^I.  Diday  strongly  recommends  the  local  application  of  ice  in  certain 
painful  affections  of  the  testis,  as  neuralgia  and  blenorrhagic  orchitis. 
Two  pigs'  bladders  partially  filled  with  ice  are  applied  one  under  the  other 
over  the  testis,  the  neighboring  parts  being  protected  with  napkins.  The 
pain  in  orchitis  is  at  first  rather  increased,  but  soon  declines,  and  in  a  few 
minutes  altogether  ceases.  The  continuous  application  of  ice  bladders 
for  twenty-four  to  forty-eight  hours  in  many  cases  permanently  removes 
the  pain.  If  on  pressure  any  tenderness  remains,  the  pain  will  return, 
and  the  ice  must  be  continued  three  or  four,  and  even  five  days  accord- 
ing to  circumstances.  On  discontinuing  the  ice,  wet  cold  cloths  should  be 
used,  to  permit  the  tissues  to  return  gradually  to  their  normal  temperature. 

Two  parts  of  finely  pounded  ice  with  one  part  of  common  salt  produces 
cold  sufficient  to  freeze  the  tissues,  and  to  deprive  them  of  sensibilitv. 
This  mixture,  largely  used  by  Dr.  Arnott,  is  confined  in  a  gauze  bag  and 
placed  in  contact  with  the  skin  till  sensation  is  abolished  and  the  skin  has 
a  leathery  feel,  and  assumes  a  shrunken  tallowy  appearance.  If  applied 
too  long,  this  mixture  may  vesicate;  but  this  will  not  occur  under  five  or 
six  minutes.  This  application  is  employed  to  prevent  the  pain  of  minor 
operations,  as  extraction  of  the  toe-nail,  and  the  opening  of  abscesses. 
Dr.  Arnott  recommends  it  in  chronic  rheumatism,  in  erysipelas,  lumbago, 
and  in  wounds.  In  chronic  rheumatism,  it  should  be  applied  to  the 
diseased  joints  for  six  minutes;  it  should  then  be  replaced  for  a  short  time 
by  pounded  ice,  to  prevent  the  occurrence  of  inflammation  from  too  rapid 
a  return  of  heat  to  the  tissues.  An  attack  of  lumbago  may  be  often  cured 
by  freezing  the  skin  over  the  painful  ])art.  Dr.  Arnott  asserts  that  when 
applied  to  wounds  this  mixture  prevents  inflammation  without  hindering 
union  by  the  first  intention. 


SPINAL    ICE-BAG SPINAL    HOT- WATER    BAG.  G9 

When  applied  for  some  hours,  this  mixture  destroys  sensibility  to 
Tjuch  a  degree  that  chloride  of  zinc  paste  may  be  used  in  sufficient  quan- 
tity to  destroy  the  tissues  to  a  considerable  depth,  without  inducing  pain 
or '^inflammation.  But  ether  spray,  so  conveniently  and  rapidly  used  in 
the  manner  introduced  by  Dr.  Kichardson,  is  now  generally  preferred 
for  the  purpose  of  freezing  the  tissues.  Chloride  of  methyl  spray  ap- 
plied by  a  suitable  instrument  from  the  condensed  gas  is  more  certain  in 
its  freezing  action  than  ether  spray. 

A  single  application  of  ether  spray  Avill  often  remove  lumbago; '  ether 
spray  sometimes  relieves  sciatica,  and  those  frontal  headaches  commonly 
called  nervous,  arising  from  either  mental  or  bodily  fatigue.  Frontal 
headache,  dull  and  uniform  in  character,  lasting  many  days,  occurring  not 
nncommonly  after  excitement  or  an  acute  illness,  such  as  erysipelas,  a 
severe  cold,  or  a  sore  throat,  often  succumbs  to  ether  spray;  but  it  is 
generally  requisite  to  freeze  the  skin  of  the  forehead. 

An  ice  poultice,  i.e.,  finely  broken  ice  in  a  thin  india-rubber  bag,  is 
a  useful  application  to  the  throat  in  tonsillitis,  scarlet  fever  and  diphtheria, 
especially  when  the  lymphatic  glands  become  greatly  swollen  and  threaten 
to  suppurate.  I  have  seen  swelling  of  the  glands  behind  the  angle  of 
the  jaw  so  great  that  swallowing  was  well-nigh  impossible,  become  so 
mucii  reduced  after  a  few  hours'  application  of  an  ice  poultice  that  the 
child  was  able  to  take  food  easily. 


ON  THE  SPINAL  ICE-BAG  AND  THE  SPINAL  HOT- 
WATEK-BAG. 

The  profession  is  indebted  to  Dr  Chapman  for  the  introduction  of 
these  appliances. 

Concerning  the  spinal  ice-bag,  Dr.  Chapman  says,  "  I  have  proved  by 
numerous  experiments  that  cold  applied  to  the  back  exerts  not  only  a 
sedative  influence  on  the  spinal  cord,  but  also  on  those  nervous  centres 
which  preside  over  the  blood-vessels  in  all  parts  of  the  body.  The  modus 
operandi  of  this  influence  on  those  centres,  and  its  effects,  may  be  thus 
stated:  '  1st.  It  partially  paralyzes  them.  2nd.  By  means  of  the  partial 
paralysis  thus  eft'ected  it  lessens  the  nervous  currents  in  the  vaso-motor 
nerves  emerging  from  the  ganglia  or  nerve  centres  acted  upon,  and 
stimulating  the  muscular  fibres  surrounding  the  arteries  influenced.  3rd. 
By  thus  lessening  those  currents  it  lessens  the  contractile  energy  of  the 
muscular  bands  of  the  arteries  to  which  those  currents  flow,  and  by  doing 
so  facilitates  the  dilatation  of  those  arteries  themselves.  4th.  By  thus 
inducing  the  condition  of  easy  dilatability  in  the  arteries  acted  upon,  it 
enables  the  blood  which  flows  in  the  direction  of  least  resistance,  to  enter 
them  in  greater  volume,  and  with  greater  force  than  before.'" 

These  elfects  are  analogous  to  those  obtained  by  Claude  Bernard.     On 

'  The  pain  and  stiffness  of  the  muscles  of  the  back  in  lumbago  may  often  be  instan- 
taneously renio\e(l  by  running  a  needle  an  inch  or  more  into  the  painful  part;  Avhen 
the  lumbago  is  double,  this  almost  painless  operation  should  be  performed  on  both  sides 
of  the  loins.  Inserted  along  the  course  of  the  sciatic  nerve,  the  needle  sometimes 
affords  instant  and  marked  relief,  even  in  very  chronic  cases  of  sciatica.  This  treatment 
indeed,  sometimes,  as  if  by  magic,  cures  severe  and  long-standing  cases.  The  passage 
of  an  interrupted  galvanic  current  will  speedily  relieve  lumbago. 


70  SPINAL    ICE-BAG SPINAL    IIOT-WATER    EAG. 

dividing  tlie  PN-mpathetic  nerve,  he  fouiul  that  the  vessels  of  the  parts 
supphed  with  this  nerve  became  dilated  and  received  an  increased  supply 
of  food,  with  a  proportionate  augmentation  of  the  vital  properties. 
Chapman  avers  that.  "Those  phenomena  which  Professor  C.  Bernard 
produced  in  the  head  of  an  animal  by  section  of  the  cervical  sympathetic 
I  have  induced  in  the  head,  thorax,  abdomen,  pelvis,  and  four  extremities 
of  man,  by  the  application  of  ice  to  the  different  parts  of  the  back.'' 

To  supply  an  increased  afflux  of  blood  to  any  part  of  the  body.  Dr. 
Chapman  ai)plies  the  ice-ljag  to  various  parts  of  the  spine;  to  the  neck 
and  between  the  shoulders,  when  more  blood  is  needed  for  the  head;  to 
the  upper  part  of  the  back,  for  the  chest  and  arms;  to  the  lower  part  of 
the  back,  for  the  abdomen,  pelvis  and  legs.     Dr.  Chapman  says: 

I.  "  Muscular  tension  is  diminished  by  tlie  application  of  ice  along  the 
sjiine."  In  support  of  this  statement  he  asserts  that  the  ice-bag  will 
prevent  the  cramps  of  diarrhoea  and  cholera,  and  is  useful  in  laryngismus 
stridulus,  chorea,  tetanus,  infantile  convulsions  and  epilepsy,  and  "  in 
prolonged  muscular  rigidity  due  to  acute  or  chronic  disorder  of  the 
nervous  centres."' 

II.  "  Sensibility  is  lessened  by  the  applicatioti  of  cold  cdong  the  spine. 
This  is  proved  conclusively  by  my  experience,  which  has  been  considera- 
ble, in  the  treatment  of  neuralgia." 

III.  "Secretion  is  lessened  by  the  application  of  cold  cdong  the  spine. 
I  have  assured  myself  by  experience  in  numerous  cases  of  the  truth  of  this 
proposition.  Morbidly  excessive  sweating,  broncJiorrhcea,  the  excessive 
action  of  the  alimentary  mucous  membrane  constituting  the  chief  cause 
of  diarrhoea,  excessive  action  of  the  kidneys,  leucorrhoea,  and  spermator- 
rhoi'a.  I  have  restrained  over  and  over  again  by  cold  properly  applied  to 
the  appropriate  part  of  the  spine." 

IV.  *'  The  jjeripheral  circulation,  and  consequently  bodily  heat,  is 
increased  by  ice  applied  along  the  spine.''  He  narrates  the  following  singu- 
lar cases  in  confirmation  of  this  proposition:  "  A  woman,  aged  sixty,  who 
for  more  than  twenty  years  had  always  been  cold  to  the  touch,  even  over 
her  shoulders  and  bosom,  though  she  was  warmly  clothed;  and  her  feet 
were  habitually  and  extremely  cold.  After  using  ice  during  three  weeks, 
several  hours  a  day.  the  whole  surface  of  the  body,  including  her  feet, 
became  wonderfully  Avarm.  She  was  extremely  astonished  by  the  increase 
of  the  temperature  of  her  body,  as  well  as  by  the  subsidence  of  every 
symptom  from  Avhich  she  had  suffered  for  so  many  years;  and  when  she 
called  upon  me  a  week  after  the  treatment  had  ceased,  her  newly-acquired 
increase  of  general  circulation,  denoted  by  her  increased  warmth,  still 
continued.  Case  2  of  this  series  affords  a  remarkable  proof  of  the  propo- 
sition in  question:  The  patient,  a  man  aged  fifty-six,  who  seemed  nearly 
seventy,  suffering  from  paralysis,  epilepsy  and  other  grave  troubles,  com- 
plained that  he  was  always  'cold  all  over;'  that  he  suffered  especially 
from  coldness  of  the  feet,  even  in  the  hottest  weather,  and  was  obliged, 
as  his  wife  said,  '  to  sit  near  the  fire  in  summer.'  Within  one  week  after 
the  treatment,  which  was  continued  three  months,  this  patient  had  become 
warm  all  over — especially  the  feet.  "Within  a  month  he  said,  '  I  feel  as 
well  as  possible;  but  very  hot,  very  hot.'  In  this  case,  after  the  ice  had 
been  left  off  for  some  days,  the  patient  became  cold  again." 

Dr.  Chapman  asserts  that  ice  applied  along  the  lower  dorsal  and  lumbar 
vertebra?,  by  increasing  the  amount  of  blood  supplied  to  the  pelvic  organs, 
promotes  menstruation,  and  will  even  restore  the  supjjressed  monthly  flux. 


INTERNAL    USE    OF    WATER. 


71 


The  ice-bag,  by  increasing  the  flow  of  blood  to  tlie  legs,  proves  very  com- 
fortable to  persons  harassed  with  cold  feet;  and  I  have  often  seen  the 
feet  become  comfortably  warm  a  few  minutes  after  the  application  of  the 
ice.  _  _  • 

r)r.  Chapman  asserts  that  ice  applied  along  the  spine  is  extremely 
useful  in  cholera  and  tetanus,  in  sea-sickness,  and  the  vomiting  of  preg- 
nancy. 


THE  SPINAL  HOT-WATEE  BAG. 

The  physiological  effects  produced  by  heat  to  the  spine  are,  as  might  be 
inferred,  the  opposite  of  those  induced  Ijy  cold.  Dr.  Chapman  says  that, 
"1st.  The  temperature  of  the  sympathetic  ganglia  being  raised,  the  flow 
of  blood  to  them  l3ecomes  more  copious,  and  the  functions  consequently 
become  more  energetic  than  before.  2d.  Their  nervous  influence  passes 
in  fuller  and  more  powerful  streams  along  the  nerves  emerging  from  them, 
and  ramifying  over  the  blood-vessels  which  they  control.  3rd.  The  mus- 
cular bands  surrounding  those  vessels,  stimulated  by  this  increased  nervous 
afflux  to  contract  with  more  than  their  usual  force,  diminish  proportionably 
the  diameter  of  the  vessels  themselves.  4th.  The  diameter  of  the  vessels 
being  thus  lessened,  the  blood  flows  thongh  them  in  less  volume  and  with 
less  rapidity  than  before;  indeed,  it  is  probable  that,  while  the  nervous 
ganglia  in  question  are  made  to  emit  their  maximum  of  energy,  many  of 
the  terminal  branches  of  the  blood-vessels  acted  upon  become  completely 
closed."     The  temperature  of  the  hot-bag  should  not  exceed  120°. 

Dr.  Chapman  employs  heat  along  the  spine  to  contract  the  blood-ves- 
sels, and  states  that  if  properly  applied,  it  will  not  only  lessen  but  will 
arrest  the  menstrual  flow.  He  asserts,  as  the  result  of  his  experience, 
that  it  will  arrest  menorrhagia  and  bleeding  from  the  nose  and  lungs.  In 
bleeding  from  the  nose  or  lungs,  the  hot  spinal  bag  must  be  applied  along 
the  cervical  and  upper  dorsal  vertebrae;  in  menorrhagia,  along  the  lower 
dorsal  and  lumbar  vertebrse. 


THE  INTERNAL  USE   OF  WATEE. 

A  FEW  remarks  may  be  made  here  conveniently  on  the  drinks  best 
suited  to  fever  patients.  The  importunate  and  distressing  thirst  often 
causes  much  restlessness  and  irritability,  whilst  these  in  their  turn  often 
increase  the  fever.  Therefore,  the  urgent  thirst  must  be  allayed;  but  if 
left  to  himself  a  patient,  to  satiate  his  craving,  will  always  drink  to  excess, 
Avhicli  is  very  liable  to  derange  the  stomach,  impair  digestion,  produce 
flatulence,  and  even  diarrhoea.  Theory  and  experience  both  show  that 
drinks  made  slightly  bitter  and  somewhat  acid  slake  thirst  most  effectu- 
ally. A  weak  infusion  of  cascarilla  or  orange-peel,  acidulated  slightly  with 
hydrochloric  acid,  was,  with  Graves  of  Dublin,  a  favorite  thirst-quelling 
drink  for  fever  patients.  Easpberry  vinegar  is  a  useful  drink.  Sucking 
ice  is  very  grateful.     Sweet  fruits,  although  at  first  agreeable  and  refresh- 


72  INTEKNAL    USE    OF    WATER, 

ing,  must  be  taken  with  care  and  moderation,  for  they  often  give  rise  to 
a  disagreeable  taste,  and  are  apt  to  produce  flatulence  or  diarrhoea. 

There  is  no  advantage  in  "curtailing  beyond  a  moderate  degree  the 
amount  of  water  drunk  by  diabetic  patients.  The  urine  and  sugar  may 
by  this  means  be  lessened,  but  the  general  distress  increased  "  (Koberts). 
In  the  thirst  of  diabetes  Prout  recommends  tepid  drinks. 

Rincing  the  mouth  with  water  as  hot  as  can  he  borne  will  often  relieve 
and  indeed  sometimes,  subdue  toothache,  though  occasionally  cold  water 
answers  better. 

Water  is  necessary  both  for  the  digestion  and  solution  of  food,  but  an 
insufficient  as  well  as  an  excessive  quantity  are  alike  harmful.  Tlie  char- 
acter of  the  fermentations,  it  is  well  known,  depends  on  the  amount  of 
water  present;  for  instance,  Avith  sugar,  if  there  is  ]:)ut  little  water  present, 
no  fermentation  will  take  place;  while,  on  the  other  hand,  with  excess  of 
water,  acetous,  instead  of  vinous  fermentation,  will  be  set  up.  It  is  more 
than  probable  that  the  quantity  of  water  taken  with  the  food  may,  in  a 
similar  way,  affect  the  changes  which  it  undergoes  in  the  stomach.  This 
much  is  certain,  that  the  drinking  habitually  an  excess  of  water  with  the 
meals  often  aggravates  dyspepsia,  and,  on  the  other  hand,  indigestion  ap- 
pears in  some  cases  to  be  connected  with  an  insufficient  quantity  of  fluid. 
Flatulent  dyspepsia  is  often  traceable  to  excess  of  drinking  at  meal  times. 

Too  much  water  taken  with  the  food  impairs  digestion,  simply  by  di- 
luting the  gastric  juice,  and  so  weakening  its  solvent  power.  The  popular 
idea  proves  to  be  correct,  that  <lrink  should  he  taken  chiefly  at  the  end  of 
the  meal,  when  it  serves  many  useful  purposes;  it  then  aids  the  passage  of 
the  peptones  from  the  intestines  to  the  blood,  and  so  favors  the  continu- 
ance of  digestion,  since  it  is  held  that  these  peptones  hinder  that  process 
until  they  pass  from  the  canal.  Moreover,  indigestible  substances,  only 
partially  dissolved,  are  carried  by  the  fluid  through  the  pylorus  into  the 
intestines,  and  there  subjected  to  further  digestion  or  are  eliminated 
with  the  motions,  thus  removing  a  source  of  irritation  from  the  stomach 
and  intestines.  The  prevailing,  perverse  modern  fashion  of  tea-drinking 
a  short  time  before  dinner  cannot  be  too  strongly  condemned;  the  early 
tea,  if  permissible  at  all,  should  be  taken  at  least  two  hours  before  dinner. 

In  our  desire  to  avoid  the  ingestion  of  too  much  drink,  we  must  be 
careful  not  to  err  on  the  side  of  undue  abstinence,  for  it  has  been  shown 
that  a  proper  amount  of  water  favors  the  secretion  of  the  gastric  juice, 
and  promotes  the  passage  of  the  peptones  into  the  blood.  Iced  drinks  at 
meal-time  are  often  harmful  by  constringing  the  vessels,  and  preventing 
the  secretion  of  the  due  quantity  of  gastric  juice. 

Chomel  described,  and  Dr.  Thorowgood  recently  narrated,  some  cases 
of  a  form  of  dyspepsia,  called  by  him  "  indigestion  of  fluids,"  characterized 
by  uneasiness  after  drinking,  and  a  splashing  noise  heard  on  percussing 
the  stomach  or  shaking  the  body,  even  when  the  patient  has  taken  no 
drink  for  some  hours.  The  best  treatment  for  this  curious  indigestion  is 
not  to  drink  till  some  time  after  a  meal,  and  as  little  as  is  compatible  with 
comfort. 

After  taking  an  emetic,  warm  water,  or  various  infusions,  as  chamo- 
mile tea  and  mucilaginous  drinks,  are  employed  to  promote  vomiting. 
For  this  purpose,  the  quantity  of  fluid  taken  should  not  be  too  large, 
otherwise  it  distends  the  stomach,  paralyzes  its  muscular  walls,  and  im- 
pedes, instead  of  promotes,  vomiting.     Half  a  pint  to  a  pint  is  sufficient. 

The  action  of  water  in  the  intestines  is  similar  to  that  in  the  stomach. 


INTERNAL    USE    OF    WATER.  78 

and  its  presence  is  necessary  for  the  absorption  of  the  digested  substances 
in  this  part  of  tlie  canal. 

A  glass  of  cold  water,  taken  early  in  the  morning,  acts  to  some  persons 
as  a  purgative.  The  cankery  taste,  hot  sensation  in  the  mouth  and  lack 
of  appetite  for  breakfast  experienced  by  many  persons  on  waking  is  gen- 
erally removable  by  drinking  half  a  tumbler  of  pure  cold  water  half  an 
hour  before  that  meal. 

A  glass  of  cold  water,  taken  immediately  on  leaving  bed,  promotes  the 
reaction  after  the  "  morning  tub." 

A  too  free  indulgence  in  fluids  often  increases  or  keeps  up  diarrhoea. 

Free  water-drinking  increases  the  water,  but  not  the  solids,  of  the 
faeces. 

Water  readily  passes  into  the  blood,  but  with  certain  limitations. 
When  the  system  has  undergone  great  loss  of  water,  this  fluid  is  ab- 
sorbed with  much  avidity,  and  its  rapid  passage  into  the  circulation  may 
materially  affect  the  blood;  indeed,  this  sudden  and  copious  influx  of 
water  is  said  sometimes  to  destroy  cattle  by  the  rapid  destruction  of  the 
blood-corpuscles  by  osmosis.  But  when  the  amount  of  water  in  the  blood 
is  already  ample,  the  absorption  of  a  further  quantity  from  the  stomach 
and  intestines  is  much  diminished. 

Excess  of  water  is  eliminated  in  various  ways.  Some,  as  we  have  said, 
passes  off  by  the  intestines;  some  is  thrown  off  by  the  skin  and  lungs; 
l3vit  most  is  excreted  by  the  kidneys.  In  six  hours  the  chief  part  is  elim- 
inated, though  after  strong  exercise  much  water  is  retained  in  the  muscles 
considerably  longer. 

Copious  drinking  exerts  a  further  action  on  the  urine  than  that  just 
mentioned;  for  not  only  does  it  increase  the  urinary  water,  but  it  also  aug- 
ments the  other  constituents  as  urea,  phosphoric  and  sulphviric  acid,  and 
chloride  of  sodium.  The  augmentation  of  these  constituents,  with  the 
exception  of  the  chloride  of  sodium,  is  permanent,  but  with  respect  to 
this  salt  the  increase  is  only  temporary,  for  after  a  while  its  amount  falls 
below  the  quantity  excreted  in  health,  and  thus  the  previous  increase  is 
balanced;  and  water  must,  therefore,  in  regard  to  common  salt,  be  con- 
sidered merely  a  temporary  eliminator.  The  case  is  different,  however, 
with  urea,  phosphoric  and  sulphuric  acid;  for  water-drinking  induces  a 
fixed  increase  of  these  substances,  giving  rise  not  only  to  their  increased 
elimination,  but  to  their  increased  formation,  which  can  happen  only  from 
augmented  disintegration  of  substances  containing  nitrogen  and  sulphur. 
Did  water-drinking  exert  solely  a  disintegrating  influence,  it  would  lead 
merely  to  a  loss  of  weight;  but  simultaneously  with  this  rapid  disintegra- 
tion a  corresponding  increase  of  assimilation  takes  place  in  the  same  tis- 
sues; whence  it  happens  that  water,  taken  under  certain  precautions,  may 
increase  both  construction  and  destruction  of  tissue,- and  so  act  as  a  true 
tonic,  improving  the  vigor  of  body  and  mind.  These  considerations 
suggest  an  explanation  of  the  benefit  often  derived  from  the  "  water  treat- 
ment "  in  hydropathic  institutions. 

The  effects  of  water-drinking  vary  in  different  persons.  The  disintegra- 
tion is  greatest  in  weakly  persons,  on  whom  this  process  may  produce 
almost  a  febrile  state.  Disintegration  is  greater  in  children  than  in  adults, 
and  greater,  perhaps,  in  women  than  in  men  A  high  temperature  of  the 
water,  or  of  the  external  air,  increases  disintegration.  Bodily  exercise 
produces  the  same  effect  (Parkes  on  Urine). 

An  old  and  useful  practice  of  drinking  a  tumbler  of  hot  water  twice 


74 


ENTEMATA. 


or  thrice  a  day,  midway  between  meals,  has  recently  been  revived.  It  is 
nseful  in  flatulent  and  acid  dyspepsia.  After  absorption  it  increases 
oxidation,  and  by  flushing  the  kidneys  tends  to  remove  effete  products 
from  the  blood.  It  is  certain  that  many  persons  find  much  relief  from 
this  treatment. 


ON  ENEMATA. 

Injections  are  used  for  a  variety  of  purposes;  to  procure  evacuations 
of  the  bowels,  to  restrain  diarrhoea,  to  ease  pain  about  the  region  of  the 
pelvis,  to  destroy  worms,  to  introduce  medicines  into  the  general  system, 
and  lastly,  to  pass  nutritive  substances  into  the  rectum,  in  cases  where  food 
cannot  be  taken  by  the  stomach. 

For  each  of  these  purposes  certain  points  must  be  attended  to  in  the 
administration  of  enemata. 

First,  concerning  injections  used  to  relieve  the  bowels.  It  must  be 
clearly  understood  that  an  enema  seldom  acts  by  merely  Avashing  away  the 
fffices;  for  it  acts  efficiently  when  the  faecal  matter  is  lodged  high  up  the 
intestines;  even  in  the  transverse  colon  or  cfecum.  An  injectioTi  probably 
stimulates  the  whole  intestinal  tract  to  more  vigorous  peristaltic  action, 
by  which  means  the  contents  are  propelled  along  the  canal,  and  finally  ex- 
pelled, the  injected  fluid  distending  the  lower  part  of  the  large  gut,  and 
so  exciting  the  vermicular  action  of  the  intestines  far  beyond  the  point 
reached  by  the  fluid.  The  object,  therefore,  is  to  distend  the  rectum  and 
the  adjoining  j^art  of  the  intestine,  but  an  enema  constantly  fails  because 
not  enough  fluid  is  introduced  to  excite  contraction.  It  is  necessary  to 
introduce  a  considerable  quantity  of  fluid,  as  much  as  two,  three,  or  even 
four  pints.  Any  one  who,  for  the  first  time,  without  due  observance  of 
certain  conditions,  attempts  to  introduce  a  cojjious  injection  into  the 
rectum,  will  in  all  probability  fail. 

When  a  copious  injection  is  to  be  given,  the  patieiit  should  be  placed 
on  the  left  side,  and  the  fluid  must  be  slowly  pumped  into  the  rectum; 
after  a  variable,  but  usually  a  short  time,  the  patient  complains  of  inabil- 
ity to  retain  more,  and  suffers  from  colicky  pain  in  the  belly,  and  an 
urgent  desire  to  empty  the  bowels.  The  pumping  must  now  be  inter- 
mitted for  a  while,  and  the  patient  directed  to  prevent  the  escape  of  the 
fluid;  but  if  he  is  nnable  to  control  the  sphincter,  the  administrator  must 
help  him.  T'his  can  be  done  in  several  ways,  each  having  for  its  object 
the  strengthening  the  contraction  of  the  sphincter.  The  simplest,  but 
not  always  the  most  successful  plan,  is  to  firmly  support  the  perina?iim 
and  structures  around  the  anus,  either  with  the  bare  hand  or  with  the  aid 
of  a  folded  towel.  Should  this  support  prove  ineffectual,  which  is  often 
the  case  after  a  considerable  quantity  of  fluid  has  been  introduced,  further 
assistance  is  afforded  by  passing  into  the  rectum,  alongside  the  nozzle  of 
the  enema-pipe,  one,  two,  or  even  three  fingers,  as  circumstances  may 
require,  and  pressing  them  with  the  nozzle  strongly  upward.  Stimulated 
in  this  way,  the  sphincter  firmly  grasps  the  fingers,  and  effectually  pre- 
vents the  escape  of  the  fluid;  indeed,  with  these  precautions,  almost  any 
amount  of  fluid  may  be  pumped  into  the  intestines.  From  time  to  time 
the  patient  will  complain  of  griping  pains  and  an  oiipressive  desire  to  go 


ENEMATA.  '  75 

to  stool,  when  the  pumping  should  be  stayed  awhile,  and  recommenced  as 
soon  as  these  symptoms  pass  away.  The  operation  over,  the  patient  must 
be  directed  to  lie  cpiite  quiet  on  the  left  side,  and  if  possible,  to  retain  the 
fluid  for  ten  minutes  or  more,  so  as  to  ensure  a  more  active  and  thorough 
contraction  of  the  bowels. 

It  need  scarcely  be  mentioned  that  if  the  rectum'or  lower  part  of  the 
large  intestines,  is  the  seat  of  cancer,  or  is  diseased  in  other  ways,  copious 
injections,  and  the  introduction  of  a  long  tube,  are  attended  with  danger. 

Sometimes  the  rectum  and  lower  part  of  the  gut  are  blocked  to  disten- 
tion with  fffices,  against  which  the  injected- fluid  impinges,  and  finding 
no  passage  it  of  necessity  flows  back  through  the  sphincter  as  fast  as  it  is 
])umpecl"in.  One  or  two  ways  may  be  adopted  to  force  such  a  blockade. 
A  hollow  tube  of  some  inches  in  length  is  passed  through  the  im- 
pacted fasces,  till  its  free  extremity  reaches  the  sigmoid  flexure,  or  even 
higher.  If  the  tube  is  passed  through  the  accumulation  in  the  intestine, 
the  injection  can  easily  proceed.  Should  this  mauieuvre  fail,  and  the  need 
is  urgent  to  obtain  an  evacuation,  then  two  or  three  fingers,  according  to 
the  yielding  of  the  sphincter,  are  to  be  introduced  in  the  rectum  to  with- 
draw the  fasces.  This  can  be  easily  accomplished  if  the  fasces  are  hard 
and  firm.  Obstinate  constipation  of  this  character  occurs  most  commonly 
in  diabetes.  The  hard  and  almost  stone-like  fasces  can  easily  be  withdrawn 
by  the  fingers  in  the  manner  described;  and  nnich  more  may  be  with- 
drawn than  is  contained  in  the  rectum,  for  although  the  intestines  may  be 
unable  to  force  the  hardened  fasces  through  the  sphincter,  they  are  quite 
capable  of  propelling  them  into  the  rectum;  consequently  as  fast  as  the 
feeces  are  withdrawn  fresh  supplies  are  propelled  downwards  within  easy 
reach  of  the  fingers. 

Various  fluids  are  employed  as  enemata.  Sometimes  simple  warm 
water  or  gruel;  at  other  times,  to  one  or  other  of  these  is  added  soap, 
turpentine,  or  castor-oil.  AVhen  castor-oil  or  turpentine  is  added  to  the 
injection,  soap  and  gruel  are  generally  employed  to  help  to  suspend  these 
substances.  It  must  be  recollected  that  castor-oil  and  turpentine  are  lighter 
than  water,  and  will  float  on  its  surface,  so  that  if  the  oil  or  turpentine  is 
added  to  the'fluid  to  be  injected,  although  the  whole  may  be  well  stirred, 
yet  as  the  injection  proceeds,  the  oil  rises  to  the  surface.  As  the  tube  of 
the  syringe  lies  at  the  bottom  of  the  vessel,  the  lower  stratum  of  the  liquid 
is  first  injected,  and  much  of  the  oil  or  turpentine  either  floats  on  the  sur- 
face or  sticks  to  the  sides  of  the  vessel,  while  the  small  portion  ultimately 
injected  operates  only  upon  the  rectum  and  the  neighboring  intestines. 
Tiie  object  should  be  to  make  the  oilor  the  turpentine,  as  the  case  may 
be,  rise  as  high  up  the  canal  as  possible,  so  as  to  bathe  and  influence  the 
mucous  lining  of  the  intestines.  The  oil  or  turpentine,  well  beaten  up 
with  three  or  four  ounces  of  gruel,  or  soap  and  water,  should  be  first  in- 
jected, and  then  the  water  is  to  be  pumped  in,  so  as  to  force  the  oil  far 
up  the  intestinal  canal. 

A  t'lblespoonfulof  senna  leaves  infused  for  ten  hours  in  cold  water, 
and  then  warmed  to  100°  Fah.,  makes  an  excellent  evacuant  enema. 

What  should  be  the  temperature  of  an  injection  ?  Tepid  fluid  is 
generally  used,  but  some  consider  that  an  injection  differing  in  tempera- 
ture widely  from  that  of  the  body  acts  more  energetically  on  the  tissues, 
and  excites  the  intestines  to  more  vigorous  action.  Thus  cold  or  hot 
water  may  be  used,  and  very  cold  water  may  be  injected  without  incon- 
venience, and  without  the  patient's  cognizance  of  its  temperature. 

It  is  unadvisable  to  use  warm  evacuant  enemata  habitually  lest  a 


76  ENEMATA. 

torpid  condition  of  the  intestines  ensue,  and  so  ultimately  render  the 
constipation  worse. 

Firm  kneading  of  the  abdomen  night  and  morning  for  ten  minutes 
often  overcomes  chronic  constipation,  especially  in  children. 

As  we  hare  said,  largo  quantities  of  water  arc  employed  to  unload 
the  bowels:  but  tiiis  is  not  the  sole  use  of  a  free  injection.  If  used  com- 
fortably warm,  it  is  very  soothing  to  the  intestines  and  to  the  neighbor- 
ing organs.  Thus,  warm  injections  will  often  much  mitigate  the  pain  of 
cancer,  either  of  the  intestines  or  of  the  adjacent  organs;  injections  also 
often  greatly  relieve  the  very  distressing  straining  desire  to  evacuate,  with- 
out any  riddance  of  fasces,  which  occurs  in  intestinal  cancer.  "Warm  in- 
jections soothe  the  pain  of  cystitis,  prostatitis,  abscess  of  the  prostate, 
and  pelvic  and  abdominal  pains  generally.     (  Vide  Opium  and  Belladonna. ) 

In  cases  of  much  flatulent  distention  of  the  Ijowels  the  addition  of 
turpentine  or  asafoetida  to  the  injection  gives  great  relief.  A  table- 
spoonful  or  two  tablespoonfuls  of  turpentine  is  enough,  and  it  must  be 
thoroughly  mixed  with  the  injection,  as  unless  it  is  freely  diluted  it  will 
cause  much  irritation  and  smarting  at  the  anus. 

In  some  instances  of  suppression  of  urine  copious  injections  appear  to 
act  beneficiallj^ 

Injections  are  often  successful  in  restraining  obstinate  or  dangerous 
diarrhcea.  It  is  by  no  means  necessary  for  the  injection  to  reach  that 
part  of  the  intestines  upon  which  the  diarrhoea  depends;  for  whether  the 
mischief  is  situated  in  the  small  or  large  intestines,  the  injection  is  equally 
beneficial,  owing,  no  doubt,  to  a  close  sympathy  between  the  different 
parts  of  the  intestines,  so  that  an  impression  made  on  one  part  is  communi- 
cated to  another.  In  restraining  diarrluea  only  a  small  quantity  should 
be  injected,  otherwise  the  intestine  is  stimulated  to  contract  and  expel  the 
enema  when  it  should  be  retained  as  long  as  possible  in  order  the  more 
effectually  to  influence  the  bowels.  An  injection  of  an  ounce,  or  at  most 
two  ounces,  is  sufficient  for  an  adult;  and  it  may  be  repeated  several  times 
a  day,  according  to  the  urgency  of  the  diarrhoea. 

The  material  used  iu  such  enemata  is  starch,  boiled  or  raw,  of  the  con- 
sistence of  cream,  and  at  a  temperature  of  100^.  An  injection  simply 
composed  of  starch  proves  effectual,  but  its  astringent  sedative  action  may 
be  much  heightened  by  the  addition  of  some  drops  of  laudanum,  graduated 
in  quantity  according  to  the  patient's  age  and  condition.  The  addition  of 
some  acetate  of  lead  or  sulphate  of  copper  renders  this  injection  more  as- 
tringent. These  injections  are  invaluable  in  cases  where  delay  is  death. 
They  will  save  many  a  life  in  the  choleraic  diarrhcea  of  children,  which  so 
rapidly  proves  fatal  unless  speedily  restrained.  The  diarrhoea  of  typhoid 
fever,  which,  if  excessive,  adds  extremely  to  the  patient's  danger,  yields 
generally  to  these  injections,  so,  usually,  does  the  diarrhoea  of  phthisis. 

Injections  are  commonly  used  to  destroy  thread- worms,  which  infest 
the  rectum  and  the  intestines  in  its  immediate  neighborhood,  but  occur 
in  no  other  part  of  the  canal.  As  the  object  of  the  injection  is  to  destroy 
these  entozoa,  a  quantity  of  fluid  should  be  employed  sufficient  to  reach  a 
little  higher  than  the  rectum.  For  an  adult  half  a  pint  is  adequate,  and  for 
a  child,  of  course,  less.  To  the  water  injected  various  substances  can  be  add- 
ed, as  common  salt,  tincture  of  sesquicliloride  of  iron,  lime  water,  quassia, 
and  various  other  similarly  acting  vermicides,  with  the  object  either  of  di- 
rectly poisoning  the  worms,  or  of  destroying  them  by  coagulating  the 
albuminous  structures  of  their  bodies.     Injections  are  always  successful  in 


ACUPUNCTURE.  77 

removing  worms,  and  thus  affording  temporary  relief;  lout  it  must  always 
be  recollected  that  the  morbid  state  of  the  mucous  coat  of  the  intestines, 
favoring  the  production  of  worms,  must  be  remedied  if  jjermanent  relief 
is  to  be  obtained.  A  teaspoonful  of  salt,  or  a  drachm  of  the  tincture  of 
steel,  to  half  a  pint  of  water,  is  sufficiently  strong  to  effect  the  destruction 
of  these  delicately-formed  animals.  Solutions  too  concentrated  must  not 
be  injected,  otherwise  inilammation  may  occur,  perhaps  severe  enough 
to  cause  sloughing  in  the  rectum  and  margins  of  the  anus. 

Nutritive  enemata  are  employed  in  stricture  of  the  oesophagus,  or 
when  tumors  press  upon  this  tube  and  render  swallowing  impossible,  in 
persistent  vomiting,  and  in  painful  diseases  of  the  stomach,  like  chronic 
ulcer.  A  nutrient  enema  should  not  exceed  three  or  four  ounces  of  bland, 
unirritating  material,  otherwise  the  lining  membrane  of  the  rectum 
becomes  irritated  and  inflamed,  a  condition  adverse  to  absorj)tion.  Mr. 
Marcus  Beck  advises  the  addition  to  the  injection  of  pepsine  and  dilute 
hydrochloric  acid.  From  experiments  on  dogs,  M.  Bauer  finds  that  the 
large  intestines  freely  absorb  peptones,  but  that  pure  soluble  albumen  is 
not  absorbed,  though  it  is  taken  up  readily  on  the  addition  of  salt.  Acid 
solutions  of  albumen,  as  meat  dissolved  in  weak  hydrochloric  acid,  are 
also  freely  absorbed.  Fats  and  starches  injected  into  the  large  intestine 
failed  to  supjjort  life  for  any  considerable  time.  It  sometimes  happens 
that  the  rectum  will  not  retain  even  four  ounces,  and  this  inability  is  more 
liable  to  occur  after  injections  have  been  continued  for  some  time.  Be- 
fore giving  a  nutritive  injection,  it  must  be  ascertained  that  the  rectum 
is  not  filled  up  with  ffeces. 

Dr.  W.  0.  Leube  employs  the  pancreas  of  the  ox  or  pig  as  a  ferment  ; 
one  part  of  finely-minced  pancreas  being  mixed  with  three  parts  of 
scraped  meat  rubbed  well  together  with  warm  water,  so  that  the  mixture 
is  easily  injected.  Fat,  not  exceeding  one-sixth  part  of  the  meat,  may  be 
added.  This  injection  is  'retained  from  twelve  to  thirty-six  hours,  and 
the  stools  afterwards  generally  possess  an  ordinary  faecal  character.  By 
ex2:)eriments  on  dogs,  Dr.  Leube  has  proved  that  by  means  of  injections  a 
considerttble  quantity  of  nitrogen  can  be  taken  up  into  the  system. 

Pancreatized  substances  are  ulso  useful  as  injections. 

Peptones  made  into  suppositories  are  also  serviceable. 

Three  to  five  eggs  beaten  up  with  four  ounces  of  20  per  cent,  solution 
of  grape  sugar  form  an  excellent  nutritive  enema.  Eggs  are  absorbed 
without  peptonization. 

Astringent  and  stimulating  injections,  composed  of  a  pint  of  water, 
and  containing  ten  to  twenty  grains  of  sulphate  of  copi)er,  or  correspond- 
ing quantities  of  nitrate  of  silver  and  sulphate  of  zinc,  prove  of  great  ser- 
vice in  restraining  the  troublesome  straining  diarrhoea  of  chronic  dysen- 
tery. In  the  earlier  stages,  also,  of  dysentery,  large  emollient  enemata 
prove  useful,  especially  by  removing  the  foetid  discharges,  and  soothing 
the  inflamed  mucous  membrane.  In  other  sections,  while  treating  of  in- 
dividual drugs,  various  additional  uses  of  enemata  are  pointed  out. 


ON  ACUPUNCTUEE. 

Acupuncture  is  a  very  successful  mode  of  treating  lumbago.     It  will 
rarely  fail  to  afford  relief,  and  in  the  majority  of  cases  it  will  cure  at 


78  ACUPUNCTURE. 

once,  though  the  himbiigo  has  lasted  a  week,  or  even  three  weeks.  It 
succeeds  best  by  far  in  typical  cases  of  lumbago,  when  the  loin  muscles  of 
both  sides  are  affected,  and  the  pain  is  most  severe  on  a  to-and-fro  move- 
ment. I  have  treated  a  large  number  of  such  cases  by  acupuncture,  and 
find  that  it  gives  almost  instantaneous  relief.  It  is  generally  sufficient  to 
run  the  needle  once  deeply,  say  an  inch,  into  the  muscles  on  each  side  of 
the  spine,  over  the  seat  of  greatest  pain.  Perhaps  it  may  be  better  to 
leave  the  needle  for  a  few  minutes  sticking  in  the  back,  but  I  have  hither- 
to found  this  proceeding  unnecessary. 

Generally,  when  the  needles  are  first  withdrawn,  the  patient  says  the 
pain  is  slightly  eased,  but  presently  it  decreases  rapidly,  and  in  three  or 
four  minutes  it  is  entirely  gone,  perhaps  a  little  stiffness  only  remaining; 
but  even  this  may  be  absent.  The  patient,  who  just  before  could  not 
bend  in  the  slightest  degree  without  the  greatest  pain,  wlio  could  not 
possibly  stoop  to  touch  his  toes,  now  bends  backwards  and  forwards  witli 
the  utmost  ease,  often  with  a  look  of  astonishment  mingled  with  incredu- 
lity, as  if  the.  cure  were  too  wonderful  to  be  true. 

Faradization  of  the  back  is  in  my  experience  almost  as  successful  as  acu- 
puncture, though  the  pain  more  frequently  returns  than  after  acupuncture. 
TJnder  either  treatment  it  sometimes  happens  that  after  several  hours 
of  relief  the  pain  returns,  and  a  renewal  of  the  treatment  may  either  be 
almost  without  avail,  or  its  influence  may  rapidly  grow  less  and  less. 
Freezing  the  back  with  etlier  spray  or  with  Arnott's  ice  mixture  is  also 
very  successful.  So  also  is  the  old-fashioned  Avay  of  ironing  the  back  Avitli 
a  common  flat  iron,  as  hot  as  can  be  fairly  borne,  passed  over  a  piece  of 
brown  paper  placed  across  the  loins.  The  thermic  hammer,  too,  often 
succeeds  in  subduing  lumbago.  These  modes  of  treatment  I  have  found 
not  so  successful  in  the  less  typical  forms  of  lumbago;  for  instance,  if  the 
pain  on  movement  is  restricted  to  one  side,  or  is  felt  only  on  twisting  or 
turning  the  body,  and  not  on  bending  to  or  fro. 

Lumbago  is  not  uiicommonly  associated  with  sciatica  or  shooting  pains 
along  some  branches  of  the  lumbar  nerves,  sometimes  the  pain  shooting 
along  the  skin  in  the  front  of  the  body,  and  along  the  lumbar  or  sacral 
plexus,  which  then  assumes  a  neuralgic  character.  When  these  two  pains 
are  associated  I  find  that  it  is  easy  to  cure  the  .lumbago,  but  that  the  scia- 
tica or  other  neuralgic  complication,  remaining  unrelieved,  is  far  more 
difficult  to  dispose  of.  Occasionally,  after  curing  the  back  by  galvanism 
or  the  needles,  the  neuralgic  pains  give  way,  to  be  replaced  by  lum- 
bago; and  when  the  lumbago  is  got  rid  of  the  neuralgic  pains  recur.  Let 
me  repeat  that  these  compound  cases  are  generally  obstinate,  and  the  neu- 
ralgic factor  most  so.  A'cupuncture  Avill  prove  useless  when  lumbago  is 
accom])anied  by  high  fever,  or  when  it  is  the  first  symptom  of  acute 
rheumatism. 

It  is  a  good  plan,  when  rid  of  the  lumbago,  to  apply  to  the  back  a 
belladonna,  or  a  lead,  or  a  Burgundy-pitch  plaster  spread  on  leather,  both 
on  account  of  the  warmth  and  the  support  it  affords.  The  Burgundy-pitch 
plaster  sticks  closest,  but  is  very  apt  to  irritate  delicate  skins,  especially  in 
warm  weather,  and  often  indeed  cannot  be  borne.  Even  lead  or  belladonna 
plaster  may  irritate  the  skin,  bringing  out  a  papular  or  eczematous  erup- 
tion, due  in  part  to  the  retention  of  perspiration,  which,  decomposing, 
irritates  the  skin.  By  removing  the  plaster  every  few  days,  wiping  it,  and 
washing  the  skin,  and  then  reapplying  the  plaster,  this  irritation  may  often 


ACUPUNCTURE.  79 

be  prevented,  or  the  plaster  may  be  perforated  after  tlie  manner  of  Al- 
€0ck's  porous  plaster.  I  have  found  acupuncture  far  less  successful  in 
the  treatment  of  sciatica;  in  a  few  cases  it  acts  no  doubt  as  speedily  and  as 
completely  as  in  lumbago,  but  this  prompt  action  is  unfortunately  the  ex- 
ception. Some  hold  that  it  is  necessary  to  pierce  the  nerve,  and  the  un- 
certain results  of  acupuncture  in  sciatica  may  possibly  be  due  to  the  needle 
sometimes  impaling  the  nerve,  but  more  frequently  missing  it.  This 
treatment  generally  gives  some,  tbough  usually  very  transient,  relief, 
lasting  only  from  a  few  minutes  to  an  hour  or  so.  In  cases  due  to  diseased 
spine  or  pressure  on  the  nerves  from  abdominal  solid  tumors,  abscesses, 
or  ffecal  accumulation,  acupuncture  is  not  appropriate.  The  needle  must 
be  thrust  in  deeply,  even  to  the  bone,  in  various  places  over  the  seat  of 
pain  in  the  course  of  the  affected  nerve.  When  only  partially  successful, 
this  treatment  removes  the  pain  along  the  course  of  the  sciatic  nerve,  but 
generally  leaves  unaffected  the  pain  below  the  knee,  especially  outside  the 
ankle.  Indeed,  I  may  add,  that  whilst  all  forms  of  sciatica  are  obstinate, 
those  cases  are  most  rebellious  when  the  pain  reaches  below  the  knee,  or 
when  it  is  restricted  to  the  region  above  the  sciatic  tuberosity. 

Dr.  Dumontpallier  finds  that  acupuncture  of  a  spot — not  the  painful 
part,  but  the  corresponding  spot  on  the  opposite  side  of  the  body — will  re- 
lieve the  pain  of  neuralgia,  acute  articular  rheumatism,  pleurodynia,  the 
relief  being  in  some  instances  permanent.  This  "  corresponding  spot"  is 
sometimes  tender;  acupuncture  over  or  near  the  seat  of  pain  also  relieves  it. 

Acupuncture,  or  incisions,  into  the  dropsical  tissues  of  the  feet  and 
ankles,  or  lower  part  of  the  calf,  is  an  old,  but  now  too  much  neglected 
mode  of  treating  both  cardiac  and  renal  dropsy.  Acupuncture  no  doubt 
sometimes  excites  erythematous  inflammation,  sufficient  to  cause  the 
dropsical,  vitally  depressed  tissues  to  slough  extensively  and  progressively. 
In  one  instance  I  have  seen  the  muscles  not  only  laid  bare,  but  dissected 
out,  over  the  lower  part  of  the  calf  to  the  extent  of  eight  square  inches, 
yet  in  this  case,  after  the  dropsy  had  drained  away,  the  tissues  recovering 
their  lost  vitality,  healed,  and  the  man  left  tlie  hospital  greatly  improved. 
It  is  better  to  make  incisions  instead  of  pricks  with  the  acupuncture 
needle.  The  incisions  should  be  from  three-quarters  to  an  inch  long,  and 
should  reach  well  into  the  subcutaneous  tissue,  or  three  or  four  punctures 
should  Ije  made  around  each  ankle  with  the  ordinary  exploring  trocar, 
thrust  up  the  leg  in  the  subcutaneous  tissues  for  an  inch  or  an  inch  and  a 
half.  The  legs  should  be  kept  dependent  and  the  wounds  covered  with 
lint  or  sponge  soaked  in  hot  boracic  acid  or  carbolic  acid  solution.  The 
feet  and  ankles  should  also  be  placed  in  hot  boracic  water  for  an  hour 
night  and  morning,  to  aid  the  escape  of  serum.  Dr.  Southey's  now  well- 
known  plan  is  highly  useful  in  many  cases. 

As  the  discharge  quickly  decomposes  and  becomes  offensive,  the 
cloths  and  sponges  used  should  be  washed  in  a  solution  of  chlorinated 
soda,  or  moistened  with  a  weak  solution  of  carbolic  acid.  These  free 
incisions  allow  the  easy  escape  of  the  dropsical  fluid,  to  the  relief  of  the 
distended  and  depressed  tissues  in  the  neighborhood  of  the  incisions,  thus 
lessening  the  likelihood  of  inflammation  and  sloughing,  which  are  very  apt 
to  occur  after  mere  pricks.  One  incision  over  eacli  outer  malleolus  is 
generally  sufficient. 

With  incisions,  though  there  is  not  much  fear  of  sloughing;  still  as 
this  untoward  event  may  occur,  it  is  better  not  to  incise,  especially  with 


80  ACUPUNCTURE. 

very  old  or  very  weuk  patients,  till  other  methods  have  been  tried  and 
have  failed.  The  benefits  are  prompt  and  striking.  8erum  runs  freely 
from  the  wonnds.  so  that  in  a  few  hours  pints  may  be  discharged.  As 
the  fluid  runs  away,  of  course  the  dropsy  grows  less,  first  in  the  upper 
parts  of  the  body,  of  the  pleura,  and  the  abdomen;  hence  the  dyspncea, 
due  to  hydrothorax,  disappears,  and  the  tightness  over  the  upper 
part  of  the  abdomen  ceases.  At  last  the  fluid  drains  out  of  the  legs,  an<l 
all  the  dropsy  is  removed,  and  without  producing  depression,  for  the 
dropsical  fluid  from  the  cellular  tissues,  unlike  inflammatory  exudations, 
contains  very  little  albumen;  so  little  that  it  only  becomes  opalescent  on 
boiling,  and  on  adding  nitric  acid. 

If  the  subcutaneous  tissue  is  hard  and  brawny,  and  will  pit  only  im- 
perfectly, then  neither  incisions  nor  Southey's  tubes  will  drain  off  any 
fluid.  An  incision,  or  one  of  Southey's  tubes,  often  sets  up  irritations 
in  the  neighborhood;  so  that  a  fresh  incision,  or  the  introduction  of  a 
fresh  tube,  draws  off  no  serum,  but  the  trocar  becomes  blocked  up  with  a 
pinkish  jelly-like  substance,  suggesting  the  idea  that  the  previous  opera- 
tions have  excited  inflammation  which  has  filled  the  intercellular  spaces 
with  this  jelly-like  substance. 

In  cardiac  dropsy  it  appears  to  me  that  this  treatment  is  more  benefi- 
cial when  due  to  aortic  than  to  tricuspid  mischief.  In  dropsy  due  to 
aortic  regurgitant  disease  there  is  a  greater  tendency  to  effusion  into 
the  pleural  and  abdominal  cavities  than  when  due  to  tricuspid  disease,  and 
the  dropsy  increases  more  rapidly.  Thus  when  dropsy  invades  the  feet, 
it  usually  spreads  quickly  up  the  legs,  and,  before  the  legs  are  extensively 
swollen  hydrothorax  often  sets  in,  embarrassing  the  already  distressed 
breathing;  so  that  in  heart  disease,  and  especially  in  the  aortic  regurgitant 
form,  in  addition  to  the  paroxysmal  panting  dyspnoea  due  to  the  heart  mis- 
chief we  have  the  constant  dyspnoea  or  orthopnoea  of  hydrothorax ;  the  or- 
thopnoea  greatly  predominating  over  the  dyspucea  directly  dependent  on 
the  heart.  The  incisions  into  the  leg  drain  off  the  fluid  from  the  upper 
parts  of  the  body,  first  emptying  therefore  the  pleural  cavities,  and 
promptly  removing  the  greater  part  of  the  dyspna3a.  This  treatment  is 
also  useful  in  the  dropsy  of  Bright's  disease. 

How  long  will  it  be  before  the  fluid  re-accumulates  and  the  advantage 
thus  gained  is  lost  ?  In  tricuspid  dropsy,  so  long  as  the  valvular  incom- 
petency continues  the  dropsy  will  return,  and  the  rapidity  of  its  recur- 
rence will  of  course  depend  on  the  degree  of  regurgitation.  In  aortic 
dropsy,  and  the  dropsy  from  Bright's  disease,  success  is  often  much 
greater.  In  some  cases,  indeed,  one  operation  often  dissipates  the  fluid, 
never  to  reaccumulate;  though  more  often  two  or  even  more  operations  at 
varying  intervals  are  necessary,  the  fluid  each  time  returning  less  and  less 
rapidly.  In  cases  of  very  extensive  dropsy,  strange  to  say,  I  have  known 
the  fluid  not  to  return,  although  the  disease  of  the  heart  or  kidneys  has 
remained  unaffected.  Thus,  the  amount  of  albumen,  and  the  quantity 
of  urine,  has  remained  just  the  same  in  cases  of  Bright's  disease,  and  yet 
after  draining  away  the  fluid  it  has  never  returned.  I  have  seen  this  ex- 
cellent result  in  a  cose  where  the  tissues  were  shiny  with  distention;  the 
abdomen  largely  distended  with  fluid  aiid  the  albumen  on  boiling  occupy- 
ing half  the  test  tube,  yet,  after  draining  away  the  dropsy  by  incisions, 
the  fluid  never  re-accumulated,  though  the  proportion  of  albumen  con- 
tinued the  same.  This  patient  remained  free  from  dropsy  more  than  six 
months  after  the  operation. 


IRRITATIOlSr    AND    COUNTER-IRRITATION.  81 


lERITATION  AND   COUNTER-IRRITATIOK 

Cantharides  applied  to  the  surface  of  the  body  soon  excites  tingling, 
smarting,  and  a  sensation  of  heat;  the  papilla?  of  the  skin  quickly  become 
reddened  and  raised;  next,  in  a  variable  time  determined  by  the  strength 
of  the  application,  on  these. papular  elevations  minute  vesicles  form,  which 
gradually  enlarge,  and  by  their  lateral  extension  soon  coalesce,  so  as  to 
form  blebs  of  various  sizes,  filled  with  a  fluid  rich  in  albumen,  and  gener- 
ally containing  some  fibrine.  It  is  of  great  importance  to  bear  in  mind 
that  the  effects  of  these  applications  are  very  different  according  to 
whether  extensive  vesication  is  produced  or  simply  reddened  skin,  with  the 
formation  of  a  few  small  miliary  vesicles.  Dr.  Graves  insisted  on  the 
different  and  even  opposite  effect  of  blisters,  according  to  the  degree  of 
their  action.  The  primary  action  of  a  blister  is  that  of  a  stimulant  to  the 
body  generally,  and  to  the  individual  organs  in  whose  neighborhood  it  is 
applied ;  but  if  allowed  to  remain  long  enough  to  produce  much  vesica- 
tion, and  to  form  large  blebs,  it  depresses  the  bodily  powers  in  proportion 
to  the  amount  of  serum  Avithdrawn  from  the  vessels,  and  so  lost  to  the 
system, — a  lowering  effect  often  exemplified  in  weakly  people,  who, 
through  the  abstraction  of  serum,  are  apt  to  remain  weakened  for  several 
days.  As  the  serum  of  blisters  contains  almost  as  much  albumen  as  the 
blood  itself,  we  might  as  well  bleed  the  patient  to  the  same  amount. 

Should  it  be  held  desirable  to  reduce  somewhat  the  patient's  strength 
and  to  produce  simultaneously  a  counter-irritant  effect  on  any  of  the  in- 
dividual organs  or  tissues  of  the  body,  then  a  blister  may  be  applied,  even 
to  vesication;  but  as  the  good  effects  of  blistering  are  for  the  most  part 
ensured  by  a  milder  measure,  treatment  so  energetic  and  so  depressing  is 
seldom  called  for. 

Dr.  Graves  commonly  employed  blisters  as  a  general  stimulant  in  cer- 
tain critical  condition  5.  In  acute  diseases,  as  the  idiopathic  fevers  and 
inflammations,  a  patient,  sometimes  already  much  prostrated,  drifts  into 
a  dangerous,  apathetic,  and  unobservant  state,  which  goes  on  till  it  reaches 
even  partial  insensibility  or  coma,  so  that  he  can  be  roused  only  with  dif- 
ficulty, and  tlieii  wears  a  stunned,  stupid,  vacant  aspect,  understanding 
very  imperfectly  what  is  said  to  him.  With  this  depressed  mental  condi- 
tion the  body  generally  sympathizes,  its  functions  becoming  more  and 
more  languidly  performed,  till  those  necessary  to  life  altogether  cease.  It 
is  a  condition  which  may  be  compared,  not  inaptly,  to  that  produced  by 
opium-])oisoning,  where  the  partial  coma  produces  a  lethargy  in  the  func- 
tions of  the  body,  their  activity  diminishes  as  the  coma  continues  and 
deepens.  Now  a  patient  in  the  partially  comatose  state  of  which  Ave  are 
speaking,  gets  no  true  and  refreshing  sleep;  yet  sleep  is  urgently  needed, 
and  an  opiate  and  plenty  of  stimulants  carefully  given,  often  produce  a 
refreshing  slumber,  out  of  Avhich  the  patient  wakes  strengthened  and 
much  improved.  (See  Opium.)  When  the  functions  are  very  languidly 
performed  this  blistering  treatment  may  Avell  precede  the  use  of  opium. 

In  this  precarious  condition,  it  is  essential  to  rouse  the  patient  from 

his  lethargic  state.     This  accomplished,  the  bodily  functions  will  act  with 

renewed  force,  and  he  will  pass  from  imminent  danger  to  comparative 

safety.     Large  blisters  or  mustard  poultices  should  be  applied  for  a  short 

6 


82  COUNTER-IRRITATION". 

time  in  quick  succession  to  various  parts  of  the  body,-  for  instance,  to  the 
chest,  the  alxlomen,  and  to  the  thighs  and  calves.  The  great  A'alue  of 
flying  bUsters  in  these  circumstances  will  Ijc  the  better  appreciated  if  we 
bear  in  mind  that  the  critical  condition  Just  descriljed  generally  occurs 
near  the  end  of  an  acute  illness,  when,  i'f  the  patient  can  be  kept  alive  for 
one  or  two  days,  the  near  danger  of  death  passes  away,  acute  diseases 
having  a  definite  duration,  so  that  if  the  patient  can  l)e  sustained  to  this 
point  his  life  may  be  saved.  Counter-irritants,  by  rousing  the  patient, 
and  spurring  the  flagging  vitality,  may  rescue  an  almost  hopeless  life. 

Preparations  of  cantharides  may  be  applied  as  stimulants  of  special 
parts  of  the  body;  for  instance,  when  with  a  general  condition  like  that 
just  described,  there  is  fear  of  hypostatic  congestion  of  the  lungs,  or  of 
pneumonia,  in  which  such  congestion  often  ends,  flying  blisters  applied 
to  the  chest,  and  perhaps,  as  recommended  by  Dr.  Graves,  along  the 
course  of  the  pneumogastric  nerves,  may.  brace  up  the  vessels,  and  avert 
a  serious  and  often  fatal  complication.  Or  we  may  stimulate  the  heart, 
and  in  intense  weakness  strengthen  its  contractions  for  a  short  time,  by 
flying  blisters  or  mustard  poultices  placed  over  the  precordial  region,  and 
then  maintain  the  advantage  thus  temporarily  gained  by  the  free  ad- 
ministration of  alcoholic  drinks. 

Flying  blisters  are  largely  employed  in  various  diseases  of  the  deep- 
seated  organs,  as  pleurisy,  pneumonia,  asthma,  biliary  and  renal  colic,  etc. 

Blisters  are  frequently  employed  in  pneumonia  and  pleurisy.  Yet 
great  divergence  of  opinion  exists,  not  only  as  to  the  stage  of  the  disease 
in  which  they  are  useful,  but  even  as  to  their  utility  in  any  case.  Some 
maintain  that  during  the  febrile  state  blisters  increase  the  fevers;  but  the 
increase,  if  any,  certainly  must  be  very  slight,  for  I  have  not  been  able  to 
excite  fever  in  fever-free  persons  by  blistering,  nor  have  I  ever  seen  it 
increase  a  fever  already  existing.  The  advocates  of  blistering  in  pneumo- 
nia maintain  that  it  removes  pain,  quiets  cough,  and  lessens  expectoration; 
but  many  competent  authorities  discredit  the  efficacy  of  blistering  in  this 
inflammation. 

Whatever  doubt  may  exist  as  to  the  influence  of  blistering  in  acute 
pneumonia  and  pleurisy,  most  observers  agree  that  it  lessens  the  pain, 
and  must  therefore  benefit  the  patient  by  subduing  the  restlessness,  op- 
pression and  sleeplessness  consequent  on  pain.  In  estimating  the  effect 
of  blistering,  it  must  be  recollected  that  in  these  acute  afl:ections  the 
severe  pain  is  of  short  duration,  and  spontaneously  lessens  or  disappears 
in  about  forty-eight  hours.  It  is,  perhaps,  not  superfluous  to  re-caution 
against  too  free  vesication. 

Opinion  is  more  agreed  on  the  usefulness  of  counter-irritation  in 
pleuris}',  after  the  subsidence  of  inflammation  and  fever.  At  this  stage 
the  prompt  application  of  large  flying  blisters,  often  repeated  and 
quickly  healed,  further  the  absorption  of  the  fluid  in  the  pleural  cav- 
ity, and  lessen  the  risk  of  the  disease  remaining  indefinitely  chronic. 
The  counter-irritant,  as  we  have  said,  should  be  frequently  applied, 
and  the  vesication,  if  it  occur,  healed  at  once;  for  all  the  good  of 
counter-irritation  is  eUected  during  the  first  few  hours  while  it  stimulates 
the  skin.  The  notion  that  free  vesication  and  the  maintenance  of  the 
discharge  by  irritating  ointment  will  drain  off  the  fluid,  as  it  were,  from 
the  water-logged  pleura?,  is  altogether  fallacious.  This  barbarous  treat- 
ment drains  important  nutritive  material  from  the  system  and  weakens 
the  patient  when  strength  is  most  needed.     We  have  already  referred  to 


COUNTER-IRRITATIOlSr.  83 

the  fact  that  blisters  will  redden  and  even  inflame  the  plenra.  Many 
consider  counter-irritation  worse  tliaii  useless  wlien  pleural  etfusion  has 
lasted  a  long  time.  The  production  of  a  free  discharge  of  serum  is  no 
doubt  useless;  but  although  in  a  long-standing  case  of  elfusioii  there  is 
but  slight  chance  of  improvement  by  any  treatment,  yet  mild  flying 
blisters  will  in  some  cases  help  to  the  absorption  of  the  fluid,  and  at  any 
rate  may  prove  serviceable,  if  in  no  other  way,  by  removing  the  trouble- 
some intercostal  pains  which  often  accompany  chronic  pleurisy;  although 
a  mustard  poultice  is  to  be  preferred. 

Counter-irritants  are  often  of  signal  service  in  removing  the  oppression 
of  the  breathing  in  asthma,  especially  of  bronchitic  asthma,  and  the  short- 
ness of  breath  accompanying  bronchitis  with  emphysema. 

They  relieve  the  pain  arising  from  the  passage  of  renal  and  biliary 
calculi. 

Counter-irritation  is  useful  in  many  other  diseases,  as  phthisis,  phle- 
bitis, sciatica,  facial  paralysis,  gleet,  leucorrhcea,  rheumatism,  gout,  and 
pleurodynia. 

Counter-irritation  is  very  beneficial  in  certain  forms  of  phthisis.  In 
the  acute  and  rapid  forms  it  is  of  little  other  service  tlian  to  remove  pain. 
But  when  the  disease  is  chronic,  when  we  have  to  treat  what  is  now  called 
the  fibroid  lung,  when  the  cough  is  paroxysmal  and  violent,  or  frequent 
and  distressing,  preveiiting  in  either  case  rest  and  sleep,  active  counter- 
irritation  of  the  chest,  corresponding  to  the  seat  of  the  disease,  often 
quickly  quiets  cough,  greatly  diminishes  the  profuse  expectoration,  and 
thus  olDviates  a  severe  drain  on  the  strength.  In  blistering  these  weakly 
patients,  vesication  must  be  avoided,  or  the  exhaustion  produced  by  the 
loss  of  serum  may  be  so  great  as  even  to  endanger  life.  In  phthisis  iodine 
liniment  is  a  better  counter-irritant  than  blisters. 

In  inflammation  of  the  superficial  veins  a  blister  applied  over  the 
course  of  the  inflamed  vessel  reduces  the  inflammation,  hastens  absorption 
or  liquefaction  of  the  coagulated  blood,  and  assists  the  restoration  of  the 
circulation  through  the  obstructed  veins. 

Blistering  is  of  the  greatest  service  in  neuralgia.  A  flying  blister  to 
the  temple  or  behind  the  ear  generally  relieves  frontal  or  facial  neuralgia. 
The  obstinate  form  of  facial  neuralgia  dependent  on  a  diseased  tooth, 
rebellious  to  all  treatment  except  extraction,  often  yields  to  a  blister;  the 
neuralgic  pains  ceasing,  although  the  toothache  may  continue.  Blisters 
relieve  the  shifting  neuralgic  pains  common  in  nervous  sensitive  women, 
although  the  pain  is  apt  soon  to  fix  upon  another  nerve;  but  flying 
blisters  will  drive  it  from  place  to  place.  In  this  migratory  form  the  pain 
may  alternate  between  a  few,  or  may  affect  in  succession  i»ost  of  the 
nerves,  producing  in  addition  great  cutaneous  tenderness;  or  the  nerves 
supplying  the  viscera  may  be  affected,  and  without  pain  produce  functional 
disturbance,  as  nausea,  sickness,  diarrhoea,  etc.  This  form  of  neuralgia, 
though  it  is  right  to  say  the  disease  lacks  many  of  the  more  distinctive 
characters  of  neui-algia,  is  most  difficult  to  cure.  The  obstinate  intercos- 
tal neuralgia  left  by  shingles,  occurring  mostly  in  old  people,  generally 
yields  to  blisters.  Anstie  points  out  that  blisters  applied  over  the  seat  of 
pain  aggravate  the  suffering;  "  but,  on  the  other  hand,  if  they  are  applied 
to  a  posterior  branch  of  the  spinal  nerve  trunk  from  Avhich  the  painful 
nerve  issues,  a  reflex  effect  is  often  produced  of  the  most  beneficial 
character. " 

Blistering  paper,  although  mild  in  its  action,  requiring  to  be  applied 


84  COtTNTER-IRRITATlON". 

some  hours,  generally  produces  enough  irritation  to  relieve  facial  and 
frontal  neuralgia;  but.  if  the  pain  continue  unabated,  a  stronger  prepara- 
tion of  eantharides  should  be  tried. 

Blisters  are  of  tiie  greatest  service  in  sciatica.'  They  should  "je  ap- 
plied every  day  or  second  day  in  the  neighborhood  of  the  sciatic  nerve, 
reaching  in  severe  cases  from  the  buttock  to  the  knee.  Free  vesication 
sometimes  succeeds  where  slight  vesication  fails.  Otlier  counter-irritants 
are  useful  in  neuralgias,  as  mustard  poultices,  croton-oil  liniment,  iodine 
paint;  but  eantharides  is  superior  to  them  all. 

Blisters  behind  the  ear,  and  es})ecially  to  the  temple,  are  very  useful 
in  rheumatic,  gouty  and  simple  inflammation  of  the  eye;  relieving  pain 
quickly,  and  subduing  inflammation,  tliough  less  rapidly.  As  it  is  im- 
])ortant  to  repeat  the  application  frequently,  blistering  paper  is  preferable 
to  stronger  preparations.  Oljstinatc^  forms  of  tinea  tai'si  sometimes  yield 
to  repeated  applications  of  flying  blisters  to  the  temples.  Counter-irrita- 
tion, by  blistering  fluid  or  croton-oil  liniment  behind  the  ear,  often 
removes  earache. 

Counter-n-ritation  at  the  epigastrium  often  allays  pain  and  obstinate 
vomiting,  due  to  disease  of  the  stomach. 

Mr.  Furneaux  Jordan  employs  counter-irritation  to  remove  enlarged 
glands.  "In  enlarged  glands,  in  abscess,  carbuncle,  boils,  erysipelas,  the 
best  locality  for  the  counter-irritation  is  around,  or  adjacent  to,  the 
disease.  Blisters  or  iodine  may  be  employed."  "In  enlarged  cervical 
glands  a  large  patch  of  iodine  irritation  at  the  back  of  the  neck,  which 
may  be  prolonged  below  the  glands,  will  certainly  prove  successful  in  a 
short  time." 

Dr.  McCall  Anderson  recommends  blistering  in  erythematous  lupus, 
and  in  chronic  skin  affections,  especially  in  eczema  of  the  hands,  when 
the  tissues,  thickened  and  cracked,  hinder  free  movement. 

In  paralysis  of  the  seventh  nerve,  dependent  on  alterations  in  its  pe- 
riphery, from  draughts  or  cold,  painting  the  skin  over  the  paralyzed 
muscles  with  blistering  fluid  will  in  some  cases  quickly  remove  it.  The 
earlier  the  application,  the  greater  the  probability  of  good  results. 

A  blister  applied  to  the  peri]ia?um  and  along  the  course  of  the  urethra 
will  sometimes  cure  a  gleet  obstinately  rebellious  to  all  the  usual  methods. 

Blisters  are  of  the  greatest  service  in  rheumatism.  Large  flying 
blisters,  applied  in  proximity  to  an  inflamed  and  painful  joint,  often 
quickly  remove  the  pain,  and  with  the  ease-  thus  brought  about  sleep 
often  ensues,  and  a  concurrent  general  improvement  takes  place  in  the 
patient's  condition.  But  blisters  have  been  of  old  recommended  as  the 
sole  or  cl^ef  treatment  of  acute  rheumatism,  and  some  apply  them,  to 
the  extent  of  free  vesication,  with  the  unfounded  hope  of  removing  from 
the  blood  the  poison  on  which  rheumatism  is  supposed  to  depend.  This 
metliod  has  the  disadvantage  of  reducing  the  strength  of  the  patient  in' 
proportion  to  the  quantity  of  serum  lost,  the  depletion  tending  to  prolong 
the  attack,  and  to  retard  the  convalescence,  usually  sufflciently  tedious 
after  a  severe  attack  of  rheumatic  fever,  Avhich  indtices  more  ana?mia  tlian 
most  other  diseases.  The  advocates  of  free  vesication  assert  that  this 
method  moderates  and  shortens  the  attack,  and  lessens  the  danger  to  the 

'  The  most  obstinate  forms  of  sciatica  are  sometimes  benefited  l\v  the  insertion  of  a 
needle  for  an  incli  or  more  in  one  or  two  places  along  the  course  of  the  sciatic  nerve. 
More  relief  is  sometimes  obtained  by  allowing  several  needles  to  remain  imbedded  in 
the  tissues  for  half  an  hour,  or  even  longer. 


COUNTER-IRRITATION.  85 

heart;  and  some  attribute  its  efficacy  to  the  influence  large  bhsters  have 
on  the  urine,  changing  in  a  few  days  the  acid  urine  of  rheumatic  fever  to 
a  neutral  or  even  alkaline  state.  I  think  that  due  regard  is  not  paid  to 
the  great  influence  age  exerts  on  the  duration  of  aji  attack  of  rheumatic 
fever;  moreover,  the  reported  cases  appear  not  to  have  recovered  more 
speedily  than  frequently  happens  in  persons  of  the  same  age,  and  mani- 
festing the  same  body  temperature,  Avho  recover  Avithout  any  medicine. 

The  nightly  application  of  a  small  flying  blister  greatly  relieves  the 
pain  and  swelling  of  chronic  and  subacute  gout,  gonorrhceal  rheumatism 
and  chronic  synovitis;  but  if  this  mild  apphcation  fail,  strong  vesication 
should  be  tried. 

Pleurodynia  usually  yields  to  anod3aie  liniments  or  mild  counter  irri- 
tants, but  sometimes  strong  vesication  is  necessary,  although  the  weakening 
loss  of  serum  may  increase  the  pain  for  a  day  or  two. 

It  is  surprising  how  much  relief  a  small  blister  no  larger  than  a  florin 
will  often  give  in  the  foregoing  diseases.  Indeed  in  many  cases  it  is  better 
to  apply  a  small  blister  nightly  to  adjacent  parts  rather  than  to  apply  a 
single  large  blister.  For  the  relief  of  pain,  as  neuralgia,  pleurodynia,  or 
spasm,  as  in  asthma,  etc. ,  a  blister  the  size  of  a  five-shilling  piece  is  gen- 
erally sufficient. 

The  active  principle  of  cantharides  being  soluble  in  oil,  it  is  useful  to 
smear  a  little  simple  oil  over  the  blistered  surface.  The  oil,  moreover, 
helps  to  maintain  the  plaster  in  contact  with  the  skin. 

It  must  be  borne  in  mind  that  blistering  paste  and  blistering  paper 
require  several  hours  to  produce  a  blister,  and  that  the  paper  rarely  pro- 
duces much  vesication.  If  a  speedy  and  sharp  action  is  necessary,  we  must 
employ  blistering  fluid,  which  sometimes  vesicates  in  twenty  minutes  to 
half  an  hour. 

The  active  principles  of  the  Spanish-fly  may  become  absorbed  by  the 
skin  in  sufficient  quantity  to  produce  congestion  of  the  kidne^^s,  strangury, 
and  its  other  characteristic  toxic  effects;  hence,  in  the  treatment  of  acute 
or  chronic  Bright's  disease,  cantharides  should  be  avoided,  as  we  are  un- 
able to  regulate  the  quantity  which  may  be  absorbed,  and  a  damaging 
amount  may  be  taken  up  by  the  skin. 

We  hope  it  has  been  made  sufficiently  plain  that,  in  the  great  majority 
of  cases,  preparations  of  cantharides  should  not  be  applied  long  enough  to 
cause  much  vesication.  The  vesicles  should  not  be  opened,  but  be  covered 
with  a  layer  of  soft  cotton-wool,  till  the  effused  scrum  is  absorbed,  when  a 
superficial  desquamation  follows,  and  no  troublesome  conseqiiences  nged 
be  apprehended.  If  blistering  is  carried  far  enough  to  produce  blebs,  the 
serum  will  not  become  absorbed,  and  the  bleb  will  at  last  burst;  even  in 
this  case  it  is  not  advisable  to  open  the  blister,  but  to  allow  the  un- 
derlying dermis  first  to  heal  partially,  when  no  ulceration  need  be  feared. 
If  the  bleb  is  punctured,  the  air  will  perhaps  irritate  the  raw  surface,  pro- 
ducing much  inflammation,  which  may  end  in  extensive  sloughing,  an 
untoward  event,  especially  apt  to  follow  the  blistering  of  young  children 
or  old  people,  or  persons  with  broken-down  health,  as  the  victims  of 
Bi-ight's  disease,  etc.  Hence,  in  such  cases,  it  is  generally  considered  ad- 
visable to  use  other  counter-irritants.     (  Vide  Mustard, ) 


86  CHARCOAL. 


CAEBON.  ANIMAL  CHARCOAL.  WOOD  CHARCOAL. 

Carbon,  in  proportion  to  its  porosit}^  absorbs  many  gases  in  consider- 
able quantity;  and  wood,  being  more  porous  tluin  animal  charcoal,  its  ab- 
sorbability is  greater. 

Charcoal  does  not  absorb  all  gases  in  an  equal  degree;  it  will  absorb 
but  little  hydrogen,  though  it  will  imbibe  a  considerable  amount  of 
oxygen,  a  large  quantity  of  sulphuretted  hydrogen,  and  a  stili  greater 
proportion  of  ammonia.  Charcoal  is  much  used  on  account  of  this  prop- 
erty as  a  disinfectant,  to  remove  bad  smells,  or  to  prevent  the  air  in  rooms 
becoming  contaminated  by  the  effluvia  from  foul  ulcers.  Its  non-volatility 
renders  it  very  inferior  to  chlorinated  lime  or  chlorine  gas  and  other 
agents  for  purifying  an*,  since  it  can  act  only  on  the  air  in  immediate 
contact  with  it. 

It  is  more  effectual  in  absorbing  the  offensive  gases  given  off  by  foul 
sores,  and  is  employed  in  the  form  of  a  poultice,  mixed  either  Avith  bread 
or  linseed-meal.  Bread,  Ijeing  more  porous,  is  to  be  preferred,  as  it 
permits  the  gases  to  permeate  the  substance  of  the  poultice,  and  so  to- 
come  into  contact  with  the  particles  of  charcoal,  some  of  which  should 
be  scattered  on  the  surface. 

After  becoming  thoroughly  moistened,  and  its  pores  filled  with  water, 
it  may  reasonably  be  doubted  if  the  charcoal  does  not  lose  its  capacity  to 
absorb  or  oxidize  gases  and  so  to  act  as  a  deodorizer.  It  is  certain  that 
charcoal  poultices  often  fail  to  act  in  this  manner.  Charcoal  may  act  by 
preventing  decomposition,  for,  when  swallowed  after  admixture  with 
v/ater,  its  pores  being  thus  filled  or  obstructed,  it  will  still  prevent  flatu- 
lence, an  effect  not  due  to  absorption ;  it  must,  therefore,  act  by  arresting 
fermentation  or  decomposition.  A  thoroughly  efficient  mode  of  employ- 
ing charcoal  is  to  fill  a  small  flat  muslin  bag  with  it,  in  a  finely  granulated 
form,  and  to  place  it  over  the  poultice  covering  the  sore. 

Charcoal  poultices  are  reputed,  on  doubtful  grounds,  to  clean  and  heal 
sloughing  or  gangrenous  wounds. 

How  does  charcoal  destroy  smells  depending  on  noxious  gases?  It 
has  been  stated  in  a  previous  page  that  it  is  endowed  wnth  the  property  of 
condensing  many  gases  in  its  pores,  and  some  accept  this  as  a  sufficient 
explanation  of  its  action.  Others  assert  that  the  oxygen  condensed  and 
accumulated  in  the  pores  of  the  charcoal,  combining  Avith  the  other  gases 
with  which  it  comes  in  contact,  breaks  them  up  and  destroys  their  ill 
odor.     It  rapidly  oxidizes  and  so  destroys  sulphuretted  hydrogen. 

A  question  of  more  practical  importance  is  whether  the  carbon  becomes- 
inert  by  use,  thus  losing  its  property  to  condense  gases  or  to  destroy  them. 
Buchheim  is  probably  right  in  stating  that  the  carbon  becomes  inert,  but 
others  assert  that  if  kept  dry,  it  Avill  retain  its  properties  unimpaired  for 
many  years.  At  all  events  exposure  to  a  dull  red  heat  restores  its  gas- 
absorbing  power. 

Charcoal  is  likewise  employed  as  a  disinfectant,  and  Dr.  Stenhouse  has 
ingeniously  devised  a  charcoal  disinfecting  respirator,  which,  no  doubt, 
will  protect  the  wearer  against  many  gases,  but  at  present  no  evidence 


CHARCOAL.  87 

exists  to  show  that  charcoal  will  destroy  the  organic  matters  which  propa- 
gate disease,  although,  acting  like  a  filter,  it  may  prevent  their  entrance 
into  the  system. 

Cliarcoal,  by  its  chemical  or  mechanical  action,  possesses  the  property 
of  carrying  down  from  sokitions  many  coloring  matters,  many  bitter  sub- 
stances, alkaloids,  and  mineral  substances.  Hence  Dr.  Garrod  advises  its 
administration  in  poisoning  by  corrosive  sublimate,  arsenic,  morphia, 
strychnia,  belladonna,  etc.,  but,  at  present,  this  treatment  has  not  found 
much  favor  with  the  profession.  As  it  is  said  that  half  an  ounce  absorbs 
only  one  grain  of  alkaloid,  large  doses  of  half  an  ounce  to  an  ounce,  or 
even  more,  must  be  given.  Charcoal  also  precipitates  the  coloring  matter 
of  urine,  carrying  down  at  the  same  time  all  the  uric  acid,  and  some  of 
the  urea  in  solution.  The  sugar  of  diabetic  urine  is  unaffected  by  char- 
coal. As  a  precipitant,  animal  charcoal  freed  from  its  earthy  impurities 
is  found  to  be  the  most  efficacious,  on  account,  it  is  said,  of  its  more  finely 
divided  state. 

Cliarcoal  is  employed  with  much  success  in  certain  diseases  of  the  stQm- 
ach.  It  is  said  to  ease  the  pain  of  chronic  ulcer,  and  of  neuralgia  of  the 
stomach,  possibly  by  checking  fermentation  and  so  preventing  the  forma- 
tion of  acids  which  must  irritate  the  stomach,  especially  when  ulcerated. 
It  is  markedly  useful  in  flatulence.  In  the  majority,  if  not  in  all  cases, 
intestinal  flatulence  is  the  result  of  gases  generated  by  fermentation.  The 
symptoms  accompanying  flatulence,  hoAvever,  are  not  always  alike,  and 
their  various  complications  afford  indications  for  treatment.  Sometimes 
"  the  wind  "  is  produced  in  enormous  quantities,  with  great  rapidity,  pro- 
ducing distention,  eructatiou,  and  mental  depression,  the  patient  com- 
plaining only  of  these  symptoms,  not  of  pain  or  of  acidity.  This'enormous 
production  of  wind,  ii-respective  of  other  symptojns,  prevails  chiefly 
among  middle-aged  Avomen,  especially  at  the  change  of  life.  This  condi- 
tion is  met  with  sometimes  during  pregaticy  and  suckling,  and  seldomer  in 
the  course  of  phthisis.  It  is  often  very  difficult  to  check  the  formation 
of  wind,  but  vegetable  charcoal  is  one  of  the  best  remedies.  Sometimes 
after  a  few  mouthfuls  of  food  the  wind  is  formed  in  quantity  so  large 
that  the  patient  is  constrained  to  cease  eating;  here  the  charcoal  should 
be  taken  immediately  before  each  meal.  Another  patient  is  not  troubled 
with  the  wind  till  half  an  hour  or  longer  after  food;  here  tlM» charcoal 
should  be  taken  soon  after  the  meal.  Five  or  ten  grains  of  charcoal  is 
generally  enough,  and  this  dose  failing,  it  seldom  happens  that  a  larger 
one  succeeds.  Some  give  a  teaspoonful  or  more  of  powdered  charcoal. 
Supposing  charcoal  to  fail  in  cases  like  these  just  described,  we  have  an- 
other efficient  resource  in  the  sulpho-carbolates,  or  carbolic  acid,  which, 
indeed,  often  succeed  when  the  charcoal  fails. 

At  other  times  profuse  formation  of  wind  is  accompanied  by  acidity. 
Cliarcoal,  administered  as  just  described,  will  generally  obviate  both  these 
symptoms;  and  sulpho-carbolates  and  carbolic  acid,  although  less  suc- 
cessful than  when  acidity  is  absent,  will  often  prevent  the  production 
of  both  wind  and  acidity. 

Some  persons  after  meals  are  troubled  with  a  little  wind,  acidit}',  and 
a  sensation  of  weight  at  the  pit  of  the  stomach.  Charcoal  will  relieve 
these  cases;  but  nux  vomica,  in  five-minim  doses  of  the  tincture,  taken  a 
feAV  minutes  before  meals,  is  to  be  preferred.  In  the  treatment  of  flatu- 
lence it  must  never  be  forgotten  to  direct  the  patient,  as  far  as  possible, 
to  abstain  from  those  kinds  of  food  prone  to  fermentation.     Sugar  and 


88  SULPHUR. 

starchy  foods  must  be  avoided  or  taken  sparingly,  and  thin  well-l)rowned 
toast,  on  account  of  the  carbonization  of  its  surface,  may  be  substituted 
for  bread.  The  meals  should  be  very  moderate,  the  food  well  masticated, 
and  drinking  postponed  till  the  meal  is  nearly  linished,  or,  better  still,  till 
an  hour  after  its  completion.     Tea  is  very  obnoxious  to  flatulent  jxitients. 

Most  of  the  charcoal  .passes  away  with  the  faeces,  though  a  little,  it  is 
stated,  finds  its  way  into  the  blood  and  lymphatics. 

Wood  is  preferable  to  animal  charcoal  for  internal  use.  It  is  often  ad- 
vantageously mixed  with  an  equal  quantity  of  bismuth,  when  flatulence 
is  combined  with  acidity  and  pain. 


CAEBONIC  ACID. 


It  is  asserted  that  this  gas  applied  to  the  eye  relieves  the  pain 
and  photophobia  of  scrofulous  ophthalmia,  and  that  injected  up  the 
vagina  it  eases  the  pain  of  ulceration  of  the  os  uteri  and  of  cancer 
and  neuralgia  of  the  uterus.  According  to  Sir  J.  Simpson,  the  inhala- 
tion of  this  gas  is  serviceable  in  chronic  bronchitis,  asthma,  and  irritable 
cough. 

Carbonic-acid  gas  is  generally  employed  dissolved  in  water.  Natural 
waters  containing  a  large  quantity  of  carbonic  acid  are  used  externally  in 
chronic  gout,  chronic  rheumatism  and  many  chronic  affections.  Car- 
bonic acid  is  an  excitant  of  the  skin,  producing  tingling  redness,  a  sen- 
sation of  .warmth,  and  increasing  the  flow  of  perspiration;  but  after 
a  time  the  gas  acts  in  some  measure  as  an  anaesthetic,  lessening  the  sen- 
sibility of  the  skin,  and  removing  or  diminishing  pain. 

Carbonic-acid  water  is  employed  in  painful  and  irritable  conditions  of 
the  stomach.  It  eases  pain,  and  checks  vomiting.  It  is  an  excellent 
addition  to  milk,  which  is  then  generally  retained,  though  previously  it 
was  rejected. 

Lime-water  and  milk  may  be  profitably  substituted  for  milk  and 
carbonic-acid  water  in  diarrhoea  with  irritability  of  the  stomach;  but  in 
case  of  constipation  carbonic-acid  Avater  and  milk  is  much  to  be  preferred. 


SULPHUE. 


SuLPHUE  dusted  on  the  skin  produces  no  effect,  but  mixed  with  lard, 
or  other  unctuous  substances,  and  rubbed  in,  it  excites  a  slight  degree 
of  inflammation;  hence  sulphur  ointment  has  been  used  to  stimulate  in- 
dolent sores  to  a  healthier  and  more  healing  condition;  but  for  such  a 
purpose  more  efficient  agents  have  superseded  sulphur  ointment,  which  is 
now  almost  entirely  restricted  to  the  cure  of  itch.  The  object  is  to  destroy 
the  insect  {acarns  scabiei)  and  its  ova,  for  it  is  on  the  presence  of  this 
animal  that  itch  depends;  and  a  knowledge  of  the  habits  of  the  acarus 
and  its  ova  suggests  the  means  best  calculated  to  effect  this  purpose.  The 
female  as  soon  as  impregnated  burrows  obliquely  under  the  skin,  and  day 
by  day  deposits  her  eggs  till  she  dies.    The  male  remains  a  wanderer  on  the 


SULPHUR.  89 

surface,  and  is  easily  attacked  and  killed  by  the  ointment.  To  reach  and 
destroy  a  female  and  her  eggs  it  is  necessary  to  break  up  the  burrows  where 
these  lie  concealed,  and  to  lay  them  bare  to  the  destructive  action  of  the 
sulphur.  The  destruction  of  the  bnrrovvs  is  easily  effected  by  the  liberal 
use  of  soap  and  water,  which  removes  the  superficial  and  dead  cuticle,  and 
exposes  the  animal  and  its  ova. 

Various  methods  of  sulphur  treatment  are  in  use,  but  it  is  sufficient 
here  to  record  only  a  few. 

M.  Hardy  claims  that  his  method  will  cure  in  four  hours.  He  first 
subjects  the"  body  for  half  an  hour  to  a  friction  of  soft  soap,  to  cleanse 
the  skin  and  lay  bare  the  burrows.  Then  follows  a  Avarm  batli  of  an 
hour's  duration;  meanwhile  the  skin  is  well  rubbed,  to  complete  the 
destruction  of  the  burrows.  Then  the  skin  is  well  rubbed  all  over — 
except  the  head  and  face,  unless  in  the  rare  instances  when  these  parts 
are  attacked— with  an  ointment  composed  of  two  parts  of  sulphur,  one  of 
carbonate  of  potash,  and  eight  of  lard. 

This  rather  severe  method  not  unfrequently  irritates  and  chaps  the 
skin,  and  is,  therefore,  inadvisable  for  delicate  skins,  especially  if  much 
eczema  or  inflammation  is  present,  affections  which  this  vigorous  treat- 
ment would  undoubtedly  much  aggi-avate. 

It  is  often  sufficient  to  treat  vigorously  only  certain  parts  of  the  body 
where  the  rash  is  most  apparent,  and  to  apply  the  ointment  to  other  parts 
in  milder  manner. 

If  the  skin  is  delicate,  much  irritated,  or  inflamed,  a  mild  soap  may 
be  substituted  for  soft  soap,  and  an  ointment,  without  alkali  and  with  less 
sulphur,  while  the  times  of  the  application  should  be  shortened,  and  in- 
stead of  one  continuous  severe  application,  the  several  washings  and  in- 
unctions should  be  repeated  on  successive  nights.  The  ointment  should 
be  left  on  all  night.  The  simple  ointment  of  the  Pharmacopceia,  little 
irritating  to  the  skin,  containing  no  potash  or  other  alkali,  is  in  most 
instances  sufficient  to  cure  itch  in  three  days.  The  patient  should  be  di- 
rected to  take  a  nightly  warm  bath,  and  to  rub  the  skin  with  soap,  bland 
or  strong,  according  to  the  condition  of  the  skin.  After  wiping  the  body 
thoroughly  dry,  the  ointment  is  to  be  well  applied  to  the  skin  by  the 
fireside,  jiist  before  bedtime,  and  to  be  washed  off  on  the  following  morn- 
ing. 

The  irritation  set  up  by  the  parasite  and  its  eggs  excites  sometimes 
more  or  less  eczema  and  impetigo.  The  treatment  adapted  to  cure  the 
itch  would  certainly  aggravate  these  accompanying  eruptions.  To  avoid 
such  a  complication,  Hebra  recommends  a  milder  ointment  of  a  different 
composition;  namely,  chalk  4  oz.,  sulphur  and  prepared  tar,  each  6  oz., 
conmion  soap  and  lard,  each  a  pound,  the  various  constituents  in  this  prep- 
aration each  serving  a  distinct  purpose.  The  chalk  helps  mechanically  to 
remove  the  dead  cuticle  and  to  l)reak  up  the  burrows;  the  tar  serves  the 
twofold  i)urpose  of  diluting  the  sulphur  and  acting  beneficially  on  the 
eczema,  while  the  soap  and  lard  further  effect  the  dilution  of  the  sulphur; 
and  the  soap,  by  virtue  of  its  alkali,  checks  the  weeping  from  the  red, 
raw,  eczematous  eruption.  This  ointment,  accompanied  with  the  use  of 
the  warm  bath,  is  employed  twice  a  day,  and  cures  completely  in  three 
days. 

After  the  itch  '.s  cured,  it  often  happens  that  the  mildest  ointments 
excite  and  increase  the  eczema  and  other  eruptions  produced  by  the 
scabies;  hence  it  is  inadvisable  to  continue  the  use  of  such  unguent  for 


90  SULPIIT  R. 

many  days.  On  withholding  this  treatment  the  rashes  produced  l)y  the 
scabies  will  frequently  disappear  at  once.  After  the  course  the  patient 
must  put  on  an  entire  change  of  linen,  and  the  soiled  clothes  should  either 
he  boiled  in  Avater,  or  heated  in  an  oven  at  a  temperature  above  212"  Fall., 
in  order  to  destroy  the  animals  and  ova  that  may  be  concealed  in  the 
linen. 

Some  maintain  that  the  sulphur  of  the  ointment  plays  no  part  in  the 
destruction  of  the  parasites,  but  that  the  fatty  matters,  by  obstructing- 
their  breathing  pores,  suifocate  and  so  destroy  them.  This  opinion  seems 
to  be  erroneous,  a  sulphur  ointment  being  far  more  effectual  than  an 
ointment  of  simple  fat.  Sulphuretted  hydrogen  is  very  destructive  to 
vegetable  and  animal  life,  and  it  is  probable  that  this  gas  is  the  efficient 
insecticide  in  destroying  the  developed  itch  hisect  by  the  conversion  of 
the  sulphur. 

Except  in  rare  cases,  the  ointment  need  not  be  applied  to  the  head 
and  face,  for  in  this  country  these  parts  are  not  often  affected.  The  dis- 
agreeable odor  of  the  ointment  may  be  in  part  concealed  by  the  addition 
of  otto  of  roses  or  other  fragrant  substances. 

To  avoid  the  disagreeable  odor  and  irritating  effect  of  sulphur,  many 
dermatologists  substitute  storax,  which  is  said  to  be  just  as  effectual. 

The  complexion  of  young  women,  in  whom  the  menstrual  flow  is  dis- 
ordered, is  sometimes  spoiled  by  numerous  small  elevations  or  pimples, 
scarcely  or  not  at  all  reddened,  and  sometimes  a  minute  pustule  on  the 
summit  of  some  of  the  elevations  forms,  the  skin  at  the  same  time  losing 
its  healthy  transparency.  This  is  a  form  of  acne  perhaps,  though  unlike 
that  commonly  seen.  Sometimes  the  eruption  appears  independently  of 
menstrual  disturbance,  and,  indeed,  may  almost  vanish  at  the  menstrual 
period,  to  recur  when  it  has  ceased.  This  eruption  may  last  months,  or 
even  years,  greatly  to  the  patient's  annoyance.  It  will,  however,  generally 
yield  to  the  a])plication,  twice  or  three  times  daily,  of  the  following  lotion: 
— Sulphur,  a  drachm;  glycerine,  an  ounce;  rose-water,  half  a  pint.  This 
lotion  speedily  benefits  the  eruption,  even  when  for  years  it  has  remained 
uninfluenced  by  other  treatment.     Acne  may  be  treated  in  the  same  way. 

An  ointment  composed  of  two  drachms  of  hypochlorite  of  sulphur  and 
an  ounce  of  simple  ointment,  or  especially  iodide  of  sulphur  ointment,  is 
very  useful  in  the  severer  forms  of  acne  (see  Sulphides).  They  should  be 
applied  twice  daily.  Where  acne  indurata  is  accompanied  by  much  acne 
punctata  frequent  washing  with  j^lenty  of  soap  and  warm  water  Avill  assist 
the  action  of  these  applications.  In  genuine  prurigo  Dr.  Anderson  applies 
night  and  morning  an  ointment  composed  of  an  ounce  of  sulphur,  six 
drachms  of  liquid  tar,  and  four  ounces  of  benzoated  lard. 

Being  quite  insoluble  in  any  of  the  fluids  of  the  mouth,  sulphur  pos- 
sesses no  taste;  btit  as  it  often  contains  a  small  quantity  of  either  sulphur- 
ous acid  or  of  a  sulphide,  it  may  partake  of  the  flavor  of  these  substances. 
It  undergoes  no  change  in  the  stomach,  and  in  no  way  affects  the  mucous 
membrane  of  this  organ. 

The  powder  of  sulphur  is  sometimes  blown  upon  the  diseased  sur- 
face in  diphtheria,  apparently  with  some  benefit. 

In  the  intestines,  however,  the  case  is  quite  otherwise.  Here  in  or- 
dinary doses  sulphur  causes  rumbling,  slight  colicky  pains,  followed  in 
a  short  time  by  a  softened  evacuation,  sometimes  soon  repeated.  From 
the  occurrence  of  colic,  and  the  semi-solid  condition  of  the  motions,  it  is 
generally  held  that  sulphur  acts  only  slightly  on  the  mucous  membrane. 


SULPHUR.  91 

but  purges  chiefly  by  exciting  contractions  of  tlie  muscular  coat  of  the 
intestines.  From  the  mildness  of  its  operation  it  is  ranked  among  the 
laxatives.  The  precipitated  sulphur  being  more  finely  divided  than 
the  sublimed,  acts  more  surely  and  effectually  as  a  purgative. 

The  too  prolonged  use  of  sulphur  excites  a  catarrhal  state  of  the 
mucous  membrane,  and  impairs  digestion. 

Sulphur  is  a  useful  purgative  in  piles  and  fissure  of  the  anus,  when 
it  is  needful  to  maintain  the  motions  in  a  soft  and  yielding  state,  so  that 
the  passage  may  not  be  irritated  and  pained  by  hard,  difficult  stools.  It 
is  also  employed  in  stricture  of  the  rectum.  In  habitual  or  obstinate 
constipation  it  often  succeeds  after  the  failure  of  other  remedies.  The 
compound  liquorice  powder  of  the  German  Codex,  or  ten  grains  of  sul- 
phur mixed  with  confection  of  senna,  are  couvenient  forms.  Com- 
pound liquorice  powder  contains  both  sulphur  and  senna,  and  is  not 
disagreeable.  Dr.  George  Bird  tells  me  that  children  like  it,  and  that 
for  them  it  is  an  excellent  purgative.  The  dose  for  adults  is  one  to 
two  teaspoonfuls  stirred  in  a  little  water  or  milk.  Apart  from  its  soft- 
ening effect  on  the  motions,  sulphur  exerts  a  beneficial  action  on  the 
I'ectum  in  prolapsus  and  in  piles.  A  morning  dose  of  five  to  ten  grains 
of  sulphur  mixed  in  a  drachm  of  confection  of  senna  is  a  very  useful 
laxative  in  piles. 

What  changes  does  sulphur  undergo  in  the  body,  and  in  what  way 
does  this  drug  act  as  a  purgative  ? 

It  has  been  suggested  that  some  of  the  sulphur  becomes  dissolved  in 
the  fat  it  meets  with  in  the  intestines,  and  thus  blended,  is  in  a  fit  condi- 
tion to  act  both  as  a  purgative  and  to  fiass  into  the  blood;  but  the  fact 
that  Avhen  sulphur  is  administered  simultaneously  Avith  much  fat.  the 
quantity  of  sulphur  in  the  ui'ine  is  not  increased,  renders  this  explanation, 
improbable. 

Some  of  the  sulphur,  undoubtedly,  is  converted  into  a  sulphide  by  the 
action  of  the  alkali  of  the  bile;  for  after  the  ingestion  of  sulphur  the  gas 
generated  in  the  intestines  contains  not  only  a  considerable  quantity  of 
sulphuretted  hydrogen,  but  much  of  the  gas  is  given  off  by  the  skin,  to 
the  extent  even  of  tarnishing  metal  articles  worn  about  the  person.  Sul- 
phur acts  as  a  purgative  through  conversion  into  a  sulphide,  and  by  virtue 
of  the  same  change  it  is  enabled  to  enter  the  blood,  a  view  supported  by 
the  fact  that  sulphides  act  in  the  same  way  as  sulphur.  Yet  a  portion  in 
the  form  of  fine  particles  j^robably  passes  "through  the  walls  of  the  intes- 
tines undissolved,  though  the  quantity  so  conveyed  is  undoubtedly  very 
small. 

The  action  of  sulphur  on  the  physical  or  chemical  constitution  of  the 
blood  is  at  present  unknown.  It  has  been  said  to  produce  salivation  oc- 
casionally, in  persons  who  had  previously  taken  mercury.  It  is  generally 
held  that  it  excites  an  increased  secretion  from  the  mucous  membrane  of 
the  air-passages  of  healthy  persons,  although  this  is  denied  by  Bucliheim. 
Graves  and  other  authorities  strongly  recommended  sulphur  in  doses  of 
from  five  to  ten  grains,  repeated  three  or  four  times  a  day  in  severe 
chronic  bronchitis,  with  abundant  discharge,  especially  when  accompanied 
by  constitutional  debility.  It  is  said  to  lessen  the  secretion,  and  to  render 
its  expulsion  easier. 

It  is  said  to  increase  both  the  frequency  and  force  of  the  heart's  con- 
tractions, and  to  promote  the  flow  of  perspiration;  but  these  assertions 
greatly  need  confirmation. 


92  SULPHIDES. 

It  is  commonly  supposed  that  the  application  of  sulphur  to  the  skin 
"will  relieve  the  pain  of  chronic  rheumatism  and  sciatica ;  but,  as  in  ap- 
plying the  sulphur,  it  is  generally  recommended  also  to  envelop  the 
ali'ected  limbs  in  soft  flannel;  it  is  difficult  to  discriminate  whether  the 
relief  is  attributable  to  the  sulphur  or  to  flannel.  Administered  inter- 
nally suljahur  is  useful  in  chronic  rheumatism  and  muscular  rheu- 
matism. 

It  is  said  that  the  internal  administration  of  sulphur  is  service- 
able in  chronic  eruptions  of  the  skin,  as  acne,  psoriasis,  impetigo,  and 
eczemn. 

Most  of  the  sulphur  taken  into  the  stomach  escapes  with  the  fasces; 
while  of  that  portion  which  enters  the  blood,  some  of  it  becomes  oxi- 
dized, and  appears  in  the  urine  as  a  sulphate,  or  one  of  the  lower  oxides 
of  sulj)hur.  The  sulphuretted  hydrogen,  from  its  great  volatility,  es- 
capes in  some  measure  b}"  the  lungs  and  skin,  and  occasionally  with  the 
m.ilk,  and  by  the.  urine. 

A  portion  of  the  ingested  sulphur  is  said  to  pass  through  the  system 
and  to  be  separated  by  the  kidneys  in  the  uncombihed  state.  Sulphur 
produces  no  change  in  the  quantity  of  the  constituents  of  the  urine, 
with  the  exception  of  the  sulphur  compounds,  which  it  augments. 

Sulphur  may  be  conveniently  administered  in  milk. 


THE    SULPHIDE    OF     POTASSIUM,    SODIUM,     AMMONIUM, 

AND  CALCIUM. 

Maxy  natural  waters  contain  one  or  more  of  these  substances.  Sul- 
phurous waters  are  found  at  Harrowgate,  Bareges,  etc.  They  have  a 
characteristic  odor,  like  that  of  rotten  eggs. 

The  three  first  substances  are  freely  soluble,  the  last  is  very  scantily 
soluble  in  water. 

Sulphuretted  hydrogen  and  sulphides  possess  the  same  action,  and 
sulphides  owe  their  virtues  to  the  sulphur  and  not  to  their  base. 

Sulphuretted  hydrogen  is  very  jDoisonous  to  both  animal  and  vege- 
table life.  It  decomposes  the  blood,  first  reducing  and  then  decompos- 
ing hsemoglobin;  hence  it  j^roduces  asphyxia.  It  also  poisons  the  tis- 
sues, and  paralyzes  the  nervous  and  muscular  tissues. 

Strong  solutions  of  these  soluble  salts  excite  active  inflammation  of 
the  skin;  weak  solutions  stimulate  the  skin, augment  its  supply  of  blood, 
and  increase  perspiration. 

Baths  containing  these  substances  are  very  useful  in  the  chronic  forms 
of  some  skin  diseases,  as  psoriasis,  eczema,  and  lichen ;  likewise  in 
chronic  rheumatism,  chronic  gout,  and  chronic  lead-poisoning.  In  these 
diseases  the  natural  sulj^hurous  waters  are  largely  used  as  baths:  but  in 
eczema  and  psoriasis  care  must  be  taken  not  to  employ  them  till  the 


SULPHIDES,  9  3 

subsidence  of  the  acute  stage,  otherwise  they  will  greatly  aggravate  the 
rash.  Obstinate  forms  of  these  skin  diseases,  rebellions  to  other  treat- 
ment, often  yield  to  sulphide  baths. 

It  has  been  attempted  to  explain  the  efficacy  of  sulj)hurous  baths  in. 
cases  of  chronic  lead  poisoning,  by  the  assumption  that  they  eliminate 
the  lead  with  the  sweat.  Under  the  use  of  these  baths  the  skin,  it  is 
said,  becomes  covered  with  innumerable  black  points  of  sulphide  of 
lead  ;  but  in  fact  the  lead  thus  blackened  was  deposited  on  the  skin  from 
external  sources,  and  was  not  eliminated  with  the  perspiration.  This 
objection,' however,  is  met  by  the  assertion  that  if  a  lead-poisoned  pa- 
tient carefully  abstains  from  all  contact  with  lead,  yet,  as  often  as  he 
uses  a  sulphurous  bath,  his  body  still  becomes  blackened  time  after  time. 
On  theoretical  grounds  it  is  hard  to  understand  how  this  metal  can  be 
eliminated  with  the  perspiration;  but  for  the  further  consideration  of 
this  point  we  must  refer  our  readers  to  the  section  on  lead. 

The  use  of  these  baths  at  a  very  high  temperature  will  often  restore 
a  considerable  degree  of  suppleness  to  joints  distorted  and  stiffened  by 
chronic  rheumatoid  arthritis.  Yet  as  other  baths  of  like  temperature 
appear  to  do  equal  good,  it  is  difficult  to  say  whether  the  sulphides  play 
any  part  in  the  beneficial  results,  although,  it  is  true,  there  is  a  wide- 
spread, and  perhaps  well-grounded,  belief  in  their  efficacy. 

A  very  efficient  application  to  cure  itch  is  made  in  the  following 
way: — Boil  one  part  of  quicklime  with  two  of  sublimed  sulphur  in  teu 
parts  of  water,  until  the  sulphur  and  lime  combine;  let  the  solution 
stand,  and  afterward  decant  the  clear  part.  Metal  vessels  should  not  be 
used  in  its  preparation.  After  the  patient  has  bathed  and  wiped  him- 
self dry  the  liquid  solution  is  to  be  painted  over  the  body.  This  appli- 
cation is  rather  irritating,  and  sometimes  produces  a  roughness  of  the 
skin,  which  may  continue  some  time.  Dr.  Bourguignon,  who  intro- 
duced this  plan,  claims  that  it  will  cure  in  half  an  hour.  (See 
Sulphur.) 

The  suljihides  are  in  part  decomposed  by  the  acids  they  encounter 
in  the  stomach,  giving  rise  to  disagreeable  eructations  of  sulphuretted 
hydrogen  gas. 

The  sulphides  in  small  doses  excite  a  sensation  of  warmth  at  the  epi- 
gastrium, but  in  excessive  doses  they  produce  active  inflammation  in  the 
digestive  canal,  with  the  customary  symptoms. 

Small  doses  act  as  a  slight  irritant  to  the  intestines,  and  determine 
gentle  relaxation  of  the  bowels.  It  is  supposed  that  sulphur  acts  as  a 
purgative,  by  its  conversion  into  a  sulphide  through  the  agency  of  the 
alkali  of  the  bile. 

In  cases  of  poisoning  by  certain  metallic  salts  the  sulpides  are  em- 
ployed, as  they  precipitate  the  metal  in  the  form  of  an  insoluble  sul- 
phide, and  so  render  it  harmless.  There  is  danger,  however,  of  giving 
the  sulphide  in  too  large  a  quantity,  since  in  its  turn  it  might  itself  ex- 
cite inflammation  of  the  stomach ;  wherefore  sulphide  of  iron  is  generally 
preferable  to  the  alkaline  sulphides. 

The  effect  of  the  sulphides  on  the  blood  after  absorption  into  that 
fluid  is  at  present  unascertained. 

Persons  habitually  breathing  air  impregnated  with  sulphuretted  hy- 
drogen are  certainly  prone  to  suffer  from  great  anaemia,  and  the  gas 
appears  to  cause  much  functional  depression. 


94  SULPHIDES. 

Sulphides  affect  chiefly  the  mucous  membranes  and  the  skin.  Given 
in  the  form  of  natural  waters,  they  are  highly  efficacious  in  chronic 
catarrh  of  the  pharynx  and  of  the  res2:)iratory  tract.  They  are  especially 
useful  in  follicular  pharyngitis,  and  are  much  resorted  to  abroad  by 
j)ublic  singers.  Some  observers  find  these  waters  very  useful  in  phthisis, 
even  in  the  febrile  form;  but  no  doubt  the  higli  altitude  where  these 
waters  are  generally  taken  exerts  some  beneficial  effect.  Many  of  these 
sulphur  waters  are  obtainable  in  this  country,  but  probably  sulphides  act 
as  well.  I  have,  however,  tried  sulphide  of  calcium,  pushed  to  its  full 
limit  of  toleration  in  phthisis,  but  without  any  apparent  good  result. 

These  substances,  in  certain  troublesome  diseases,  often  yield  strik- 
ing results. 

This  group  of  remedies  influences  the  suppurative  process  in  a  very 
decided  and  manifest  manner. 

Thus  the  common  case  of  a  sore,  discharging  a  thin,  watery,  unheal- 
thy ichor,  Avill  speedily  undergo  a  healthy  change  under  the  administra- 
tion of  sulpliide  of  calcium,  the  discharge  becoming  at  first  more  abun- 
dant, afterward  diminishing,  and  throughout  continuing  creamier, 
thicker  and  healthier,  with  all  the  characters  indeed  of  "  laudable  "  pus. 

Dr.  Bergeon,  of  Lyon,  after  extensive  trials,  strongly  recommends 
intestinal  injections  of  sulphuretted  hydrogen  in  consumption.  He 
mixes  the  gas  with  carbonic  acid  gas,  as  atmospheric  air  does  not  be- 
come absorbed.  Carbonic  acid  should  be  liberated  from  bicarbonate  of 
soda  by  the  action  of' an  acid,  and  then  mixed  with  sulphuretted  hydro- 
gen set  free  from  the  following  solution :  sodium  sulphide,  10  grammes, 
distilled  water,  100  c.c,  to  which  is  added  15  c.c  of  the  following  solu- 
tion :  tartaric  acid,  25  grammes,  salicylic  acid,  1  gramme,  distilled  water, 
100  c.c.  A  special  apparatus  is  required.  The  gas  must  be  adminis- 
tered twice  a  day,  and  slowly  discharged  from  the  apparatus,  each  charge 
of  the  elastic  bottle  being  expelled  into  the  colon  every  ten  or  fifteen 
seconds.  In  phthisis  he  claims  that  it  lessens  cough  and  expectoration ; 
the  fever  abates,  the  appetite  increases,  sleep  improves,  and  weight  in- 
creases. Its  mode  of  action  is  not  yet  explained.  It  does  not  destroy 
the  tubercle  bacillus.  The  treatment  is  said,  too,  to  be  useful  in  chronic 
bronchitis  and  asthma,  and  notably  to  check  profuse  secretion.  The 
gas  is  evidently  quickly  absorbed.  It  rather  accelerates  and  strength- 
ens the  pulse,  and  quickens  respiration.  If  too  much  is  administered, 
the  pulse  becomes  very  frequent,  amounting  to  120  or  more,  and  it  be- 
comes feeble;  respiration,  too,  becomes  much  hurried,  may  reach  even 
100  per  minute.  The  face  is  flushed,  aspect  anxious,  and  the  j^atient 
may  become  quite  unconscious,  and  yet,  in  ten  minutes  the  ill  effects 
may  quite  pass  away.  The  reports  of  subsequent  observers  corroborate 
in  varying  degrees  these  statements.  Some,  however,  maintain  that  no 
specially  good  results  are  due  to  this  treatment.  Owing  to  the  trouble 
and  annoyance  of  this  method,  it  has  not  at  present  received  a  full  and 
impartial  trial. 

The  sulphides  appear  to  me  to  possess  the  property  of  preventing 
and  arresting  supparation.  Thus  in  inflammation  threatening  to  end 
in  suppuration  they  reduce  the  inflammation,  and  avert  the  formation 
of  pus.  This  effect,  for  instance,  is  manifested  by  the  action  of  the 
local  application  of  sulphur  compounds  in  acne  indurata,  a  subject  to  be 
dealt  with  further  on  more  in  detail. 


SULPHIDES.  95 

After  tlie  formation  of  pus,  tlie  influence  of  this  group  on  the  sup- 
puration process  is  still  more  conspicuous;  then  the  sulphides  hasten  ma- 
turation considerably,  whilst  at  the  same  time  they  diminish  and  circum- 
scribe the  inflammation,  promote  the  passage  of  the  pus  to  the  surface, 
and  the  evacuation  of  the  abscess.  Their  efficacy  may  be  frequently 
demonstrated  in  cases  of  the  following  kind.  An  unhealthy  child,  from 
six  to  twelve  months  old,  perhaps  in  the  course  of  measles  or  scarlatina 
is  the  subject  of  a  slight  sore-throat,  which  produces  behind  the  angle  of 
the  jaw  considerable  enlargement  of  the  glands,  and  the  swelling,  of  stony 
hardness,  may  be  large  enough  to  interfere  with  swallowing,  and  even  to 
push  the  head  on  one  side.  Very  deep-seated  suppuration  takes  place, 
and  for  a  long  time  there  is  neither  redness  of  the  skin  nor  fluctuation, 
and  the  pus  very  slowly  makes  its  way  to  the  surface,  so  that  a  fortnight, 
three  weeks,  or  even  a  month  may  elapse  before  the  abscess  bursts,  or  is 
fit  to  be  opened,  when  a  deep  hole  is  left,  with  considerable  indurations 
around  it.  So  great  are  the  pain  and  constitutional  disturbance  that  the 
child  sometimes  dies;  and  even  if  this  fatality  be  averted,  the  deep  dis- 
charging hole  heals  very  slowly,  owing  to  the  indurated  and  unhealthy 
state  of  the  adjacent  tissues.  Now,  in  such  a  testing  case,  if  we  give  a 
tenth  of  a  grain  of  sulphide  of  calcium,  mixed  with  a  grain  of  sugar  of 
milk,  every  hour  or  two,  the  results  are  most  striking.  The  pain  and 
constitutional  disturbance  begin  to  diminish,  the  swelling  becomes  smaller, 
the  pus  reaches  the  surface  in  four  or  five  days,  leaving  when  it  is  evacu- 
ated a  benign  wound  which  quickly  heals.  The  effects  of  these  remedies 
are  equally  conspicuous  in  mammary  abscesses,  although  in  rare  instances 
they  appear  temporarily  to  increase  the  pain — a  fact  which  seems  some- 
times to  hold  good  with  respect  to  boils,  though  as  a  rule  the  ]uxin  is 
speedily  mitigated.  Singular  to  say,  I  have  found  these  remedies  much 
less  useful  in  forwarding  the  maturation  and  expulsion  of  pus  in  indolent 
buboes;  but  in  such  cases  my  experience  of  the  sulphides  has  been  but 
small. 

It  may  be  urged  that  it  is  difficult  to  imagine  how  these  remedies  can 
produce  effects  so  different  and  apparently  opposite  as  the  dispersion  of 
inflammation  in  one  case,  and  the  expulsion  of  pus  in  another;  poultices, 
however,  and  hot  fomentations,  both  subdue  inflammation  and  prevent 
suppuration,  and  in  other  cases  considerably  hasten  the  evacuation  of  pus. 

In  boils  and  carbuncles  these  remedies  yield  excellent  results.  A 
tenth  of  a  grain  of  sulphide  of  calcium  given  hourly,  or  a  quarter  or  half 
a  grain  three  or  four  times  a  day,  will  generally  prevent  the  formation 
of  fresh  boils,  while  it  lessens  the  inflammation  and  reduces  the  area  of 
existing  boils,  and  quickly  liquefies  the  core,  so  that  it  separates  much 
more  speedily,  thus  considerably  curtailing  the  course  of  the  boil.  Where 
the  skin  is  not  yet  broken,  and  the  slow-separating  core  not  yet  exposed, 
the  sulphides  often  convert  the  boil  into  an  abscess,  so  that  on  bursting 
pus  is  freely  discharged,  and  the  wound  at  once  heals;  or  if  the  centre  of 
the  hardened  swollen  tissues  is  not  yet  dead,  the  pustule  dries  up,  the 
inflammation  subsides,  and  a  hard  knot  is  left,  which  disappears  in  a  few 
days,  without  the  formation  of  a  core,  and  without  any  discharge.  These 
remedies  meanwhile  improve  the  general  health,  removing  tliat  debility 
and  malaise  ordinarily  so  markedly  associated  with  boils  aiid  carbuncles. 
In  some  cases,  however,  as  in  the  deep-seated  boils  and  abscesses  of  dia- 
betes, they  are  less  efficacious.  In  carbuncles  the  sulphides  will  generally 
be  found  equally  serviceable,  melting,  as  it  were,  the  core  into  healthy 


96  SULPHIDES. 

pus,  and  so  quickly  expelling  the  dead  and  otherwise  slow- separating  tis- 
sue. Belladonna  applied  over  abscesses  and  carbuncles  reduces  inflam- 
mation and  allays  pain.  The  skin  should  be  thickly  smeared  with  equal 
parts  of  belladonna  and  glycerine,  and  over  this  a  poiiltice  should  be  ap- 
plied and  the  smearing  renewed  each  time  the  poultice  is  changed.  Poul- 
tices, however,  being  liable  to  bring  out  a  fresh  crop  of  boils,  it  is  well  to 
smear  belladonna  ointment  some  distance  round  but  not  over  the  boil,  and 
then  to  apply  a  poultice,  the  greasy  application  thus  protecting  the  neigh- 
boring tissues.  Or,  still  better,  apply  a  belladonna  or  opium  plaster  on 
leather,  with  a  hole  the  size  of  the  boil,  around  the  SAvelling,  and  through 
the  opening  smear  glycerine  and  belladonna,  covering  all  with  a  small 
poultice.  The  leather  ]ilaster  efficiently  protects  the  surrounding  skin, 
and  averts  the  production  of  fresh  boils.  I  have  thought  it  worth  while 
to  point  out  these  useful  accessory  plans  of  protecting  the  boil;  ])ut  it 
is  scarcely  necessary  to  observe  that  whilst  investigating  the  effects  of  sul- 
phides I  have  employed  them  alone,  or  at  most  sometimes  using  only  a 
poultice.  Indeed,  the  effect  of  sulphides  on  boils  is  so  excellent  and 
prompt  that  external  applications  are  generally  unnecessary,  though  of 
course  they  are  required  in  the  treatment  of  carbuncles.  Sulphides 
should  be  continued  till  the  discharge  has  nearly  ceased,  and  till  stimulat- 
ing applications  are  needed,  when  tonics  must  replace  sulphides. 

The  good  effects  of  sulphides  are  conspicuous  in  certain  scrofulous  sores 
not  uncommonly  seen  in  children.  Scrofulous  children  during  the  first 
fcAV  months  are  sometimes  subject  to  indolent  abscesses  in  the  cellular  tis- 
sue which  nm  a  very  slow  course.  At  first  only  small  hard  substances  are 
observable,  no  larger  than  a  pea,  under  the  skin,  Avliich  is  of  natural  color, 
and  movable  over  them.  The  small  substances  next  suppurate  and  gradu- 
ally enlarge,  the  skin  becomes  adherent,  and  changes  in  color  to  red  or 
even  violet,  while  the  smaller  vessels  in  their  neighborhood  sometimes 
become  enlarged  and  even  varicose.  The  tumors  may  attain  the  size  of  a 
florin,  and  when  maturated  feel  soft  and  boggy.  After  a  time  a  small 
circular  opening  appears,  not  larger,  perhaps,  than  a  pin's  head,  through 
which  escapes  a  thin  unhealthy  pus.  If  deep-seated,  as  on  the  buttocks, 
or  occurring  in  fat  children,  there  may  be  very  little  or  no  discoloration  of 
the  skin.  The  cliief  noticeable  character,  then,  is  the  small  sharply-cut 
opening,  as  if  a  piece  had  been  punched  out.  These  formations  follow 
one  another,  and  may  continue  to  distress  the  child  for  months  or  years. 
In  mild  cases  a  few  only  may  form,  whilst  in  severe  cases  there  may  be  at 
one  time  ten  or  a  dozen  in  different  stages  of  development.  When  they 
heal  they  leave  a  white,  sharply-defined,  but  not  deeply-depressed 
scar.  Xow  this  troublesome  and  pertinacious  condition  will  give  Avay 
speedily  to  the  administration  every  hour  or  two  of  a  tenth  or  twentieth 
of  a  grain  of  sulphide  of  calcium.  The  formation  of  new  nodules  is  at 
once  checked,  for  a  fresh  one  rarely  now  makes  its  appearance,  although 
for  months  or  years  the  child  may  have  been  infested  with  successive  crops. 
Many  of  the  abscesses,  especially  in  a  very  early  stage  of  development,  dry 
up  and  disperse;  others  generally  speedily  maturate  their  contents,  the 
thin  and  unhealthy  pus  becoming  creamy  and  "  laudable."  The  abscesses 
already  in  an  open  state  improve,  the  pus  becoming  healthier,  and  the 
wounds  healing  quickly. 

In  some  cases,  in  addition  to  these  subcutaneous  formations,  the  bones 
likewise  become  affected.  The  phalangeal  bones  of  the  hand  are  most 
frequently  attacked,  though  not  uncommonly  the  metacarpal,  and  more 


SULPHIDES.  97 

rarely  tlie  metatarsal.  Where  the  phalangeal  bones  are  affected  one  or 
several  of  the  fingers  become  nodose.  For  a  long  while  the  skin  remains 
pale  and  freely  movable,  bnt  then  suppuration  ensues,  the  swelling  in- 
creases, the  skin  becomes  red  and  painful,  and  after  a  time  slowly  softens 
at  one  point,  remaining  boggy  for  a  considerable  period  before  the  abscess 
opens  naturally.  Then  generally  a  little  bone  separates,  or  in  bad  cases 
the  whole  of  the  shaft  comes  away,  leaving  the  epiphyses  behind.  AVhen 
an  opportunity  occurs  to  examine  these  bones  before  suppuration  sets  in 
the  shaft  is  found  considerably  enlarged,  very  pale,  and  the  cancellous 
structure  infiltrated  with  a  straw-colored  firm  substance,  whilst  the  epi- 
physes and  their  cartilages  are  healthy.  Even  in  these  severe  cases  the 
sulphides  will  benefit  considerably;  thus  before  suppuration  has  set  in,  or 
whilst  it  has  made  little  way,  they  often  remove  the  swelling,  though  large 
doses  may  be  required.  After  much  suppuration  the  good  effects  of  sul- 
phides depend  in  a  great  measure  on  the  amount  of  the  disease  of  the 
bone.  If  the  whole  shaft  becomes  necrosed  of  course  the  sore  will  not 
heal  till  the  bone  has  b^en  got  rid  of,  but  suppuration  often  occurs,  and 
yet  but  little,  or  perhaps  none,  of  the  bone  dies.  In  such  a  case  the  sul- 
phides hasten  the  expulsion  of  the  pus,  and  when  the  skin  is  already  broken 
they  improve  the  character*  of  the  wound  and  the  discharge,  and  heal  the 
sore,  leaving  a  sunken  scar  adherent  to  the  bone,  whilst  the  finger  slowly 
assumes  its  natural  proportions.  The  sulphides  similarly  affect  large 
indolent  abscesses  on  the  back  of  the  hands  or  on  the  feet.  Whilst  thus 
influencing  locally  strumous  formations  and  abscesses  these  remedies  im- 
prove the  child's  health,  which  perhaps  had  failed  before  in  spite  of  cod- 
liver  oil  and  steel  wine.  That  the  improvement  is  due  to  the  sulphide  is 
shown  by  the  fact  that  the  amendment  occurs  when  this  drug  only  is  ad- 
ministered. Sometimes,  instead  of  improving  the  general  health,  sul- 
phides produce  marked  anaemia,  due,  I  think,  to  the  administration  of 
too  large  a  dose.  On  prematurely  discontinuing  the  sulphide  fresh  for- 
mations are  apt  to  appear,  especially  on  the  occurrence  even  of  a  slight 
illness;  indeed,  a  severe  illness  will  often  excite  a  few  fresh  abscesses,  in 
spite  of  the  sulphides. 

In  suppurating  scrofulous  glands  in  the  neck  the  sulphides  appear  to 
me  to  exercise  a  very  beneficial  influence  by  hastening  the  elimination  of 
the  pus,  and  subsequently  the  cheesy  scrofulous  matter.  After  the 
abscesses  have  burst,  and  continue  to  slowly  discharge  a  scanty,  unhealthy 
pus,  and  when  the  edges  of  the  sores  have  become  much  thickened  and 
indurated,  the  sulphides  render  the  discharge  more  abundant,  thick, 
creamy,  and  healthy,  considerably  hasten  the  evacuation  of  the  scrofulous 
matter  which  prevents  the  healing  of  the  wound,  and  at  the  same  time 
soften  the  round  indurated  edges,  so  that  the  sore  heals  much  more 
speedily.  If  small  doses  appear  to  affect  these  sores  inadequately,  larger 
doses,  as  half  a  grain  or  a  grain,  should  be  given  several  times  a  day,  or 
even  every  two  hours.  I  need  hardly  say  that  to  compass  the  results 
described  the  treatment  must  be  continued  several  weeks,  for  when  the 
sores  have  been  discharging  perhaps  for  months  or  even  years,  it  is  vain 
to  expect  much  amendment  in  a  few  days. 

The  topical  effect  of  sulphur  ointment,  or  of  an  ointment  of  the 
hypochlorite  of  sulphur,  or,  still  better,  of  the  iodide  of  sulphur  of  the 
Pharmacopoeia,  is  very  marked  on  acne  indurata  and  acne  rosacea.  Here, 
again,  according  to  the  stage  of  the  eruption,  the  effects  are  twofold,  and 
even  opposed.     If  applied  at  the  very  commencement  of  the  eruption,  as 


98  CHLORINE. 

soon  Jis  the  little  hard  knot  is  felt  under  tlie  skin,  the  ointment  iirrests 
further  development  and  quickly  dissipates  the  hardness.  For  instance, 
if  smeared  over  the  hardness  just  before  going  to  hed,  scarcely  any  in- 
duration will  be  felt  in  the  morning,  though  after  a  time,  perhaps  from 
exercise,  or  the  irritation  from  washing,  much  of  the  hardness  may  return, 
to  be  again  removed  by  a  renewed  application  of  the  ointment,  so  that  in 
two,  or  at  most  three  days,  it  will  completely  disperse  a  papule  which 
threatened  to  become  of  considerable  size.  When,  however,  the  nodule 
has  advanced  further,  and  suppuration  has  set  in,  then  the  effect  of  the 
ointment  is  much  like  that  of  sulphides  administered  internally,  on  boils. 
The  ointment  hastens  maturation,  limits  the  swelling  and  hardness,  and 
thus  considerably  curtails  the  duration  of  the  eruption.  Nay,  further,  if 
rubbed  over  the  skin  it  appears  to  check  the  formation  of  the  acne  spots; 
rubbed  over  the  nose  and  neighboring  parts  of  the  face  in  acne  rosacea, 
its  effects  are  often  striking.  Not  only  does  it  act  as  in  acne  indurata, 
but  the  hardened,  swollen  tissues  become  softened  and  reduced  to  a  more 
natural  state.  I  have  found  the  iodide  of  suLphur  useful  likewise  in 
hromic  acne;  it  reduces  the  eruption,  or,  at  least,  lessens  the  size  of  each 
spot  considerably.  The  ointment  should  be  thickly  smeared  over  the 
eruption  of  acne  night  and  morning. 

To  adults  sulphide  of  calcium  is  best  administered  in  a  coated  pill  in 
quarter  or  half  grain  doses,  three  or  four  times  a  day.  For  children  I  use 
the  following  formula?:— Mix  a  grain  of  the  sulphide  of  calcium  (the 
member  of  this  group  which  I  always  employ)  with  half  a  pint  of  water, 
and  give  to  a  child  a  teaspoonful  hourly.  It  is  essential  that  the  medicine 
in  this  form  should  be  comjwunded  daily,  since  the  salt  rapidly  becomes 
oxidized  and  changed  into  a  sulphate,  so  that  in  a  very  short  time  none  of 
the  sulphide  remains.  It  is  still  more  convenient  to  give  the  sulphide 
in  powder.  A  child  should  take  one-tenth  or  one-twentieth  of  a  grain, 
and  the  powder  should  be  put  upon  the  tongue  and  washed  down  with  a 
draught  of  water,  or  a  tenth  of  a  grain  made  into  a  small  varnished  pill, 
should  be  taken  hourly. 

In  employing  these  agents  in  baths,  porcelain  or  wooden  vessels  must 
be  used,  as  the  sulphide  attacks  and  discolors  most  metals.  These  baths 
emit  a  powerful  odor,  very  offensive  to  some  people. 


CIILOEINE  GAS. 
CHLORINE   WATER. 
CHLORINATED   SODA  ]       ,  ,,    ■       ,   ,  • 
CHLORINATED   LIME  \  ^'''^  ^^^^^^  solutions. 

These  substances  are  used  as  disinfectants,  antiseptics  and  deodorizers. 

This  action  depends  in  part  on  their  power  to  destroy  the  organisms 
that  produce  putrefaction,  and  those  that  produce  the  septic  poison  or  are 
themselves  the  cause  of  specific  fevers. 

Whatever  power  they  possess  in  these  respects  is  due  either  to  chlorine 
or  to  hypochlorous  acid. 

Chlorine  gas,  jwssessing  very  strong  chemical  affinities,  acts  probably 
by  seizing  with  avidity  upon  the  hydrogen  in  organic  and  inorganic  sub- 
stances, thus  breaking  up  their  composition. 


CIILORIN"E.  99 

Hypoclilorous  acid,  wliicli  is  given  off  abundantly  by  the  two  last- 
mentioned  members  of  this  group,  is  an  active  oxidizing  agent.  It  yields 
up  its  oxygen  readily,  and  is  tlius  destructive  to  many  substances;  at  the 
same  time  chlorine  gas  is  set  free,  which  in  its  turn  acts  in  the  way  just 
described. 

These  substances  are  employed  in  sick  rooms  as  disinfectants,  Init  the 
evidence  in  favor  of  their  possessing  such  a  property,  although  very 
generally  held  to  be  sufficient,  is  inconclusive. 

Some  infecting  matters,  it  is  true,  when  treated  with  these  substances, 
lose  their  power  to  propagate  disease;  but  it  is  impossible  to  subject 
objects,  and  particularly  persons,  to  such  destructive  action  as  is  found 
to  be  required  in  these  experiments.  It  is  uncertain,  then,  whether,  in 
the  gaseous  form,  or  in  the  dilute  state  in  which  it  can  be  borne,  chlorine 
can  destroy  germs  and  their  spores. 

Chlorine  is  a  deodorizer  acting  in  two  ways.  It  can  destroy  the  germs 
which  produce  putrefaction,  or  it  can  destroy  the  noxious  gases  produced 
by  decomposition,  such  as  the  ammonias,  sulphuretted  hydrogen,  and 
sulphides  of  ammonium,  which  create  the  disagreeable  odors  of  sick  rooms. 
■  Owing  to  its  gaseous  state,  chlorine  is  admirably  suited  as  a  deodorizer; 
it  penetrates  every  cranny  of  the  room,  searching  out  and  destroying 
noxious  and  offensive  gases. 

While  these  substances  may  be  conveniently  and  profitably  used  as 
deodorizers,  it  must  always  be  borne  in  mind  that  it  is  better  to  prevent 
bad  smells  by  free  ventilation,  and  that  chlorine  gas  itself  has  an  odor  very 
disagreeable  to  most  people.  If  these  deodorizers  are  often  required  in  a 
sick  room,  it  is  a  sure  sign  that  ventilation  is  defective,  and  probably  that 
the  nurse  is  careless. 

To  disinfect  unoccupied  rooms,  the  air  must  be  very  strongly  impreg- 
nated with  chlorine.  M.  Eegnault  recommends  the  following  plan,  first 
blocking  the  chimney  and  closing  the  room: — 8ew  one  pound  of  chloride 
of  lime  loosely  in  a  strong  canvas  bag,  and  put  it  into  a  mixture  composed 
of  a  pint  and  a  half  of  commercial  hydrochloric  acid  with  four  and  a  half 
pints  of  water.  Then  after  twenty-four  hours,  freely  ventilate  the  room 
for  forty-eight  hours. 

Besides  their  capacity  to  destroy  many  offensive  gases,  these  substances 
prevent  decomposition;  hence  they  are  useful  as  washes  or  injections  to 
prevent  the  decomposition  of  the  pus  of  sores,  or  cavities  of  the  body. 
Sloughing,  foul-smelling  sores,  should  be  washed  with  solutions  of  these 
or  other  kindred  substances.  Chlorine  compounds,  being  slightly  stimu- 
lating, improve  the  condition  of  indolent  sores.  After  an  operation,  the 
pus  which  sometimes  collects  in  the  hollows  left  becomes  corrupt,  and 
gives  off  foetid  gas,  which  becomes  absorbed  and  poisons  the  system. 
This  may  be  avoided  by  washing  out  the  cavities  several  times  daily  with 
a  weak  chlorine  solution.  In  puerperal  peritonitis,  or  at  any  time  when 
the  uterus  contains  decomposing  matter,  the  vagina  must  be  thoroughly 
and  frequently  washed  out,  some  deodorizing  and  antiseptic  substance 
being  mixed  with  water.  Many  obstetricians  in  puerperal  fever  and  other 
conditions  wash  out  in  this  Avay  the  cavity  of  the  womb  itself. 

Antiseptic  solutions  in  sloughing  of  the  throat,  as  in  scarlet  fever  or 
diphtheria,  and  in  salivation  and  ulceration  of  the  mouth,  will  remove 
the  foul  odor  and  tend  to  arrest  putrefaction. 

A  strong  solution  of  chlorinated  soda  has  been  highly  recommended 
in  diphtheria. 


100 


IODINE. 


The  deodorizing  and  antiseptic  substances  chiefly  in  use,  besides  the 
members  of  this  group,  are  iodine,  permanganate  of  potash,  and  car- 
bolic acid.  Solutions  of  permanganate  of  potash,  unless  unnecessaril}' 
strong,  are  bland  and  unirritating;  while  the  chlorine  and  carbolic  acid 
solutions  are  stimulating,  and  even  irritating.  Carbolic  acid  is  in  some 
respects  inferior  to  the  other  members  of  this  group,  since  it  seems  to 
lack  power  to  destroy  offensive  gases. 


IODINE. 


Iodine,  like  chlorine,  possesses  powerful  chemical  affinities,  and  com- 
bine energetically  with  many  organic  and  inorganic  substances,  and  is  a 
disinfectant,  antiseptic,  and  deodorizer. 

Iodine  maybe  used  as  a  deodorizer  and  disinfectant  by  simply  suspend- 
ing over  the  patient's  head  a  lidless  chip-box,  or  a  saucer,  containing  ti 
few  grains. 

It  is  volatile,  and  readily  penetrates  the  animal  textures. 

It  is  applied  to  the  skin  for  a  variety  of  purposes.  A  strong  solution, 
as  the  liniment,  is  frequently  used  as  a  rubefacient  and  counter-irritant, 
producing  at  first  a  sensation  of  heat  and  burning,  which  may  increase  to 
an  unendurable  extent.  The  inflammation  it  excites  separates  the  cuticle 
to  a  greater  or  less  extent  from  the  dermis,  so  slight  it  may  be  that  in  a 
few  days  mere  desquamation  results;  but  if  the  liniment  is  strong  it 
rapidly  produces  even  a  blister  containing  serum  with  much  fibrine,  leav- 
ing sometimes  a  permanent  scar — a  misadventure  which  should  be  care- 
fully avoided. 

The  skin  can  generally  bear  two  lightly-painted  coats  of  the  Pharma- 
copoeia liniment,  unless  a  previous  application  has  rendered  it  thin  and 
delicate,  when  one  coat,  lightly  applied,  is  all  that  can  be  endured.  If, 
as  sometimes  lia2')pens,  the  application  causes  much  pain,  the  iodine  should 
be  washed  off  with  spirits  of  wine,  gin,  or  whiskey,  eau  de  Cologne,  or, 
best  of  all,  with  a  solution  of  iodide  of  potassium,  and  the  pain  subdued 
by  the  application  of  a  poultice.  On  and  around  the  painted  spot  iodine 
liniment  will  often  excite  a  crop  of  itching  papules,  which  often  appear 
as  late  as  the  third  or  fourth  day  after  the  application. 

The  liniment  applied  to  the  chest  as  a  counter-irritant  in  chronic 
pleurisy  is  used  to  promote  the  absorption  of  the  fluid  accumulated  in  the 
pleura.  Painted  under  the  clavicles  in  the  chronic  forms  of  phthisis,  it 
is  of  great  service  to  allay  hai'assing  cough,  and  to  check  secretion  from 
the  bronchial  tubes  and  cavities  of  the  lungs.  Painted  over  the  front  and 
back  of  the  chest  it  often  affords  relief  In  chronic  bronchial  catarrh  by 
easing  the  cough  and  lessening  the  expectoration.  It  may  also  be  painted 
on  any  part  of  the  chest  affected  with  pleurodynlc  pains,  although  a 
mustard  poultice  is  preferable,  as  it  can  be  reapplied  should  the  pain 
return.  The  iodine,  however,  may  succeed  where  the  mustard  fails. 
Iodine  is  painted   around  joints  affected  with  chronic   rheumatism  or 


IODINE.  101 

chronic  gout,  or  with  chronic  synovitis.  Like  blisters,  it  eases  the  pain, 
and  often  removes  the  fluid  distending  the  cavity  of  the  Joint;  Uke 
blisters,  too,  it  often  causes,  for  a  few  days,  increased  distention  of  the 
joint,  tli(^  good  etfects  not  becoming  apparent  till  later.  This  increase  of 
the  swelling  may  be  regarded  as  an  indication  of  the  success  of  the  appli- 
cation. The  liniment  is  useful  when  painted  on  the  skin  over  a  bron- 
chocele.  It  should  be  applied — though  it  can  seldom  be  borne  oftener 
than  once  a  week — as  often  as  the  state  of  the  skin  will  permit,  till  the 
tumor  disappears.  The  liniment  or  tincture  is  recommended  as  an  ap- 
plication to  lupus, painted  not  only  on  the  edges  of  the  sore,  but  also  over 
the  tissues  around  it.  It  is  said  to  arrest  the  spreading  of  the  disease. 
In  the  form  of  ointment  its  applications  are  manifold.  It  is  of  the  great- 
est benefit  in  chilblains,  if  Avell  rubbed  over  the  affected  part  before  the 
skin  is  broken.  The  tincture  lightly  painted  over  the  part  is  often  used 
for  chilblains,  but  the  ointment  is  far  more  efficacious,  curing  unbroken 
chilblains  in  one  or  two  days.  In  this  harassing  affection  I  know  nothing 
so  effective.  The  intolerable  itching  of  chilblains  is  often  very  difficult 
to  relieve.  Hot  water  often  affords  temporary  relief.  I  have  heard 
])atients  say  that  an  infusion  of  celery,  used  as  hot  as  can  be  borne,  is 
liighly  efficacious,  and  that  the  efficacy  is  not  simply  due  to  the  hot  Avater, 
as  the  celery  infusion  affords  far  more  enduring  relief  than  simple  hot 
water.  Benzoin,  iodine  dissolved  in  ammonia  (colorless  tincture  of  iodine 
and  liniment  of  ammonia)    are  each  useful  in  chilblains. 

Iodine  ointment  is  often  useful  in  removing  some  of  the  non-inflam- 
matory pains  of  the  chest;  but  these,  not  being  always  of  the  same  nature, 
discrimination  must  be  exercised.  When  the  pain  is  situated  in  the 
muscles  (myalgia),  and  these  are  teiuler  on  pressure,  while  the  skin  may 
be  pinched  without  pain,  this  ointment  is  indicated.  But  if  the  tender- 
ness is  situated  in  the  skin  (pleurodynia),  belladonna  is  to  be  preferred. 
I  believe  Dr.  Hare  first  pointed  out  this  distinction,  and  it  is  one  which 
holds  true,  though  not  without  exceptions. 

The  ointment,  tincture  and  liniment  of  iodine  are  used  for  the  same 
purposes;  but  it  must  be  recollected  that  the  ointment  and  tincture  are 
much  milder  preparations,  and  will  even  after  several  applications  prodnce 
but  a  small  amount  of  desquamation.  When  a  strong  irritant  action  is 
needed,  the  liniment  must  be  employed;  and  a  medium  effect  can  be  pro- 
duced by  suitably  diluting  the  liniment  with  spirit. 

The  tincture  or  the  ointment  is  often  applied  over  indurated  swollen 
glands,  or  parts  thickened  by  inflammation,  with  the  intention  of  remov- 
ing the  diseased  products;  but  when  painted  over  scrofulous  glands,  or 
glands  subacutely  inflamed,  care  must  be  taken  lest  the  applications  in- 
crease the  inflammation  and  favor  suppuration. 

Iodine  is  a  powerful  parasiticide,  and  is  used  for  this  purpose  in  skin 
diseases.  A  mixture  of  light  oil  of  wood  tar  in  the  proportion  of  two 
drachms  of  iodine  to  an  ounce  of  oil  of  wood  tar  has  been  recommended 
by  Mr.  Coster  as  an  efficient  application  in  tinea  tonsurans.  It  usually 
produces  no  pain,  and  without  doubt  prevents  the  extension  of  this 
troublesome  disease. 

In  many  cases  where  the  disease  involves  a  large  part  or  the  whole  of 
the  head,  this  application  may  be  painted  over  the  entire  scalp.  Occasion- 
ally, however,  the  skin  is  so  delicate  that  this  extensive  applicatio'n  cannot 
be  borne,  and  then  it  should  be  apj^lied  only  to  a  small  surface  and  painted 
on  a  fresh  part  daily.     In  some  cases  it  gives  so  much  pain  that  it  cannot 


102 


IODINE. 


be  at  all  tolerated.     Coster's  paint,  as  miglit  be  expected,  is  far  more 
effectual  in  the  circumscribed  than  in  the  diffuse  form. 

The  liniment,  ointment,  or  tincture  will  remove  herpes  cireinatus. 
One  application  of  the  liniment  is  enough,  but  the  ointment  or  tincture 
must  be  applied  once  or  twice  daily. 

Painting  the  affected  and  circumjacent  skin  with  a  solution  oJ'  iodine 
is  strongly  recommended  to  prevent  the  spread  of  erysipelas. 

Mr.  Jordan  speaks  highly  of  the  application  of  the  liniment  in  the 
neighborhood  of  local  inflammation;  applied  so  as  to  produce  vesication 
around  a  bubo,  an  abscess,  or  a  carbuncle,  it  considerably  reduces  inflam- 
mation. 

In  hydrocele,  iodine  in  solution,  generally  the  tincture,  is  perhaps 
the  best  fluid  to  inject  into  the  serous  cavity  surrounding  the  testicle. 
The  serous  fluid  is  first  drawn  off,  then  the  iodine  is  injected  into  the 
cavity,  which,  exciting  adhesive  inflammation,  the  contiguous  surface  of 
the  sac  unites,  and  the  fui'ther  effusion  of  serum  is  rendered  impossible. 

Iodine  solution  is  injected  into  joints  affected  with  white  swelling,  into 
the  cavity  of  the  pleura  in  empyaema,  into  ovarian  tumors  after  tapping, 
and  into  large  abscesses  after  their  evacuation.  Ten  ounces  of  the  tinc- 
ture, and  even  more,  may  be  injected  into  an  ovarian  sac.  The  results 
of  the  cases  thus  treated  are  most  satisfactory.  The  injection  of  white 
swellings  is  said  to  produce  no  ill  symptoms,  and  unless  there  is  caries  or 
necrosis  of  the  bones,  or  swelling  of  the  surrounding  parts,  this  treatment 
is  generally  favorable. 

In  chronic  pleurisy,  after  the  side  has  been  evacuated,  iodine  injec- 
tions remove  the  great  fcetor  often  present  from  the  decomposition  of  pus 
in  the  pleural  sac,  and  at  the  same  time  diminish  the  secretion  from  its 
walls.  The  injection  must  at  first  be  weak,  say  four  or  five  grains  of 
iodine  and  iodide  of  potassium  to  a  pint  of  water,  but  when  the  structures 
have  become  accustomed  to  it  a  stronger  solution  may  be  employed.  No 
doubt  this  treatment  is  often  successful;  still  it  must  be  carried  out  with, 
the  greatest  caution,  otherwise  inflammation,  with  high  fever,  may  set  in, 
and  prove  fatal. 

Milder  injections,  containing  permanganate  of  potash,  or  a  small  quan- 
tity of  creosote,  or  quinia,  are  generally  adequate  to  destroy  the  fa3tor,  in 
which  case  the  more  powerful  agents  are  of  course  not  to  be  used.  Since 
the  Avasting,  the  loss  of  appetite,  and  depression  in  cases  like  these  is 
mainly  traceable  to  the  absorption  of  poisonous  gases  and  putrid  fluids,  it 
is  of  the  highest  importance  to  keep  the  sac  free  from  them. 

Iodine  solutions,  injected  into  the  cavities  of  large  abscesses,  their  con- 
tents having  been  discharged,  often  prove  very  serviceable.  The  tincture 
itself  may  be  freely  used;  the  cavity  of  the  abscess  should  subsequently  be 
kept  clean  and  sweet  by  frequent  washings  with  a  weak  solution  of  per- 
manganate of  potash.  Iliac  and  lumbar  abscesses,  too,  may  be  treated  in 
this  way. 

Lister's  method  of  treating  abscesses  and  empyemas  has,  in  most 
cases,  rendered  the  use  of  chlorine  and  iodine  applications  unnecessary. 

The  hypodermic  injection  of  tincture  of  iodine,  in  five  to  fifteen  or 
more  minims,  is  now  much  used  for  the  cure  of  bronchocele.  Iodine  is 
useful  also  in  hypertrophied  tonsils  and  glanduLir  tumors.  The  tinc- 
ture must  be  injected  into  the  glandidar  eidargement,  and  not  into  the 
connective  tissue,  or  ulceration  will  ensue.  The  injection  should  be  re- 
peated once  or  twice  a  week. 


I 


IODINE.  103 

The  tincture  of  iodine  may  be  used  as  an  inhalation,  witli  signal  bene- 
fit in  the  four  following  instances: — 

1.  In  the  chronic  forms  of  phthisis  (fibroid  lung);  when  the  expecto- 
ration is  abundant,  and  the  cough  troublesome,  an  inhalation  used  night 
and  morning  will  generally  lessen  the  expectoration,  and  allay  the  cough. 

2.  In  children,  six  to  ten  years  of  age,  after  measles,  or  independently 
of  it,  on  exposure  to  cold,  seized  with  hoarseness,  a  hoarse  hollow  cough, 
and  some  wheezing  at  the  chest.  This  affection  involving  the  larynx, 
trachea,  and  larger  bronchial  tubes,  often  proves  very  obstinate,  is  apt  to 
return,  and  to  persist  a  considerable  time. 

3.  In  some  epidemics  of  diphtheria,  the  inhalation  recommended  by 
Dr.  Waring-Curran: — 4  grains  of  iodine,  4  grains  of  iodide  of  potassium, 
4  drachms  of  alcohol,  and  4  ounces  of  water.  A  teaspoonful  of  this  should 
be  added  to  boiling  water,  kept  hot  by  a  spirit  lamp  whilst  the  steam  is 
inhaled.  As  the  patient  becomes  accustomed  to  the  iodine,  the  quantity 
of  the  solution  may  be  increased  till  half  an  ounce  of  it  is  used  at  each 
inhalation.  It  should  be  repeated  many  times  a  day,  and  each  inhalation 
continued  from  eight  to  twelve  minutes. 

4.  In  itching  of  the  nose  or  of  the  inner  can  thus  of  one  or  both  eyes, 
sneezing,  running  at  the  nose  of  a  watery  fluid,  weeping  of  the  eyes,  and 
severe  frontal  headache.  Patients  of  various  ages  are  greatly  troubled, 
often  for  many  years,  with  daily  attacks,  lasting  it  may  be  several  hours. 
Iodine  inhalation  often  removes  this  affection  at  once,  and  when  it  suc- 
ceeds partially  it  almost  always  lessens  the  headache  and  the  discharge 
from  the  nose.     Its  effect  is  most  marked  on  the  itching.      (See  Arsenic.) 

I  generally  adopt  the  following  simple,  handy,  cleanly,  and  effectual 
plan  of  inhalation: — Heat  well  a  jug  capable  of  holding  about  two  pints, 
by  rinsing  with  boiling  water,  then  partially  fill  with  boiling  water,  into 
which  pour  twenty  to  thirty  drops  of  the  tincture  of  iodine;  then  direct 
the  patient  to  put  his  face  over  the  mouth  of  the  jug,  and  to  breathe  the 
iodized  steam;  covering  both  the  jug  and  the  patient's  head  with  a  towel 
to  prevent  the  escape  of  the  steam.  This  inhalation  should  be  used  night 
and  morning,  for  five  minutes,  or  a  little  longer.  Occasionally  an  excess 
of  iodine  Avill  temporarily  produce  a  sensation  of  soreness  in  the  chest,  and 
throat,  sometimes  with  redness  of  the  conjunctiva,  running  from  the  nose, 
and  pain  in  the  head. 

In  chronic  ozaena  it  is  useful  to  flush  the  nose  with  a  solution  of 
common  salt,  containing  a  few  drops  of  tincture  of  iodine. 

The  tincture  is  useful  to  remove  tartar  from  the  teeth;  and  to  stimu- 
late the  gums  when  they  begin  to  recede,  leaving  the  teeth  exposed,  and 
more  liable  to  decay.  It  should  be  painted  over  the  gums  close  to  the 
teeth.  An  iodine  gargle,  made  with  two  or  four  drachms  of  the  tinc- 
ture to  eight  ounces  of  water,  has  been  recommended  to  allay  mercurial 
salivation;  and  the  tincture  of  iodine  is  applied  to  sores  of  the  throat, 
syphilitic  and  simple. 

Iodine,  in  undue  quantity,  irritates  and  excites  inflammation  in  the 
delicate  structure  of  the  stomach,  inducing  pain  at  the  epigastrium, 
vomiting,  diarrhoea,  sometimes  much  collapse,  and  even  death.  It  should 
be  given  soon  after  a  meal,  when  the  mucous  membrane  is  protected  by 
the  food. 

When  iodine  reaches  the  stomach  or  intestines,  and  certainly  when 
it  enters  the  blood,  theory  would  suggest  that  this  drug  becomes  converted 


104  POTASSIUM   AND    SODIUM    SALTS. 

either  into  an  iodide  of  potassium,  or,  more  probably,  of  sodium,  and 
thenceforth,  in  its  career  through  the  body,  it  would  behave  as  an  iodide. 
Practically,  there  is  much  to  confirm  this  view,  as  the  action  of  iodine 
on  the  distant  organs  of  the  body  is  very  generally  admitted  to  be  iden- 
tical with  that  of  the  iodides;  yet  some  practical  authorities  state,  that 
in  chronic  rheumatic  arthritis  the  tincture  of  iodine  is  serviceable  when 
the  iodide  of  potassium  fails,  although  it  is  difficult  to  understand  how 
this  should  be.     Some  becomes  converted  into  an  albuminate. 

Dr.  Anderson  recommends  iodine  in  malarial  fever.  He  has  treated 
"upward  of  300  c;ises  with  almost  invariable  success."  He  gives  from 
twelve  to  fifteen  minims  of  the  compound  tincture.  It  is  said  it  is  not 
only  a  cheap  but  an  efficient  substitute  for  quinine,  curing  some  cases 
of  ague  where  quinine  has  failed. 


A  FEW  INTRODUCTOEY  REMARKS  REGARDING  THE  REL- 
ATIVE EFFECTS  OF  POTASSIUM  AND  SODIUM  SALTS. 

Ix  prescribing  a  medicine  it  is  important  to  recollect  that  an  ele- 
ment on  combining  with  another  element  does  not  lose  its  characteristic 
action,  and  that  the  action  of  a  salt  is  the  sum  of  the  action  of  its  com- 
ponent parts.  For  instance,  in  bromide  of  potassium  we  still  have  the 
action  both  of  bromine  and  potassium,  and  these  substances  on  combin- 
ing do  not  lose  their  individual  properties,  nay,  their  separate  activities 
are  but  little  diminished,  so  that  all  potassium  salts  appear  to  be  equally 
poisonous  to  the  animal  body.  Of  course  if  the  salt  has  an  acid  or  alka- 
line reaction  it  will  act  in  virtue  of  its  acidity  or  alkalinity;  but  from 
numerous  experiments  all  neutral  salts  of  potash  appear  to  be  equally 
poisonous. 

We  often  prescribe  remedies  for  their  acid  radicle  only.  This  is 
the  case  with  iodides  and  bromides.  Iodides  act  certainly  in  most 
diseases  in  virtue  simply  of  the  iodine  or  bromides  in  virtue  of  the 
bromine.  Hitherto  the  practice  has  largely  prevailed  of  prescribing 
potassium  comjjounds  of  iodine  and  bromine  in  preference  to  the  sodium 
or  ammonium  salts,  but  this  practice  ought  certainly  to  be  avoided,  for 
potassium  salts  are  far  more  poisonous  than  the  sodium  salts,  without 
being  in  many  cases  more  therapeutically  active.  It  is  obvious  we  ought 
to  avoid  this  unnecessary  depression,  arising  from  the  use  of  jDotassium 
salts  in  preference  of  sodium  salts. 

I  will  now  draw  attention  to  the  differences  chiefly  between  sodium 
and  potassium  salts;  differences  in  degree,  but  in  some  particulars  like- 
wise in  kind. 

Potassium  salts  are  highly  poisonous  to  all  the  animal  tissues,  suspend- 
ing the  functional  activity  of  the  nervous  and  muscular  structures,  and 
probably  of  all  the  tissue*  of  the  body.  On  the  other  hand,  the  corre- 
sponding sodium  salts  are  almost  atoxic,  even  when  administered  in  much 
larger  doses  than  the  potassium  salts. 

This  difference  between  potassium  and  sodium  compounds  is  well  ex- 
emplified in  experiments  on  the  ventricle  of  the  frog's  heart.  Potassium 
salts  markedly  affect  both  nervous  and  muscular  functions.  Small  doses 
affect  the  spontaneous  contractions,  at  first  greatly  reducing  their  fre- 


POTASSIUM    AND    SODIU3[    SALTS.  105 

quency,  and  then  arresting  them,  whilst  considerable  contractility  still 
persists,  which  may  be  made  evident  by  stimulating  the  ventricle  by  an 
induction  shock.  A  slightly  increased  dose  of  the  potassium  salts  soon 
suspends  contractility  likewise;  sodium  salts,  on  the  contrary,  aft'ect  spon- 
ta7ieous  action  very  little,  so  that  as  long  as  contractility  lasts  spontaneous 
action  continues.  Sodium  salts,  moreover,  must  be  given  in  doses  fourteen 
to  fifteen  times  larger  than  the  potassium  salts,  in  order  to  suspend  mus- 
cular contractility. 

Whilst  potassium  salts  largely  increase  the  latent  period  in  an  induced 
muscular  contraction,  sodium  salts  produce  very  little  effect. 

Potassium  salts  greatly  augment  the  duration  of  the  period  of  dimin- 
ished excitability.     Sodium  salts  very  slightly  extend  this  period. 

AVhen  the  ventricle  is  strongly  faradized  it  is  thrown  into  a  tetanic 
state.  Potassium  salts  in  small  closes  prevent  this  tetanuS;  whilst  sodium 
salts,  even  in  much  larger  doses,  but  slightly  lessen  it. 

Faradization  arrests  the  spontaneous  contractions  in  a  ventricle  poisoned 
with  only  a  small  quantity  of  a  potassium  salt;  but,  on  the  contrary.  Fara- 
dization applied  to  a  ventricle,  even  when  arrested  by  sodium  salt,  in- 
duces the  return  of  contractions,  one  contraction  being  piled  on  the  top 
of  another,  and  thus  a  considerable  contraction  of  the  ventricle  is  produced, 
and  is  sustained,  as  in  tetanus. 

Thus  we  see  that  potassium,  even  when  combined  and  forming  neutral 
salts,  still  acts  as  a  powerful  poison,  whilst  so  weak  is  the  action  of  sodium 
that  it  can  hardly  be  called  a  poison.  From  these  facts  it  is  obvious  that 
when  we  seek  to  profit  by  the  action  of  the  acid  radicle  of  iodine  or  bro- 
mine we  should  give  the  preparation  of  sodium  in  preference  to  that  of 
potassium.  So  far  I  have  based  this  conclusion  on  physiological  experi- 
ment on  animals,  but  clinical  experience  has  long  taught  the  same  lesson; 
indeed,  potassium  salts  are  far  more  powerfully  depressing,  whilst  not 
more  therapeutically  active  than  the  sodium  salts.  These  considerations 
have  led  latterly  to  the  introduction  of  hydriodic  and  hydrobromic  acids, 
and  of  iodoform  in  place  of  iodides  and  bromides.  These  ])reparations 
are  still  on  their  trial,  in  respect  to  their  relative  value  comjjared  Avith 
bromides  and  iodides. 

The  poisonous  action  of  potassium,  sodium,  ammonium,  and  some  otiier 
salts,  depends  mainly  on  the  percentage  dose,  not  on  the  total  amount 
conveyed  to  the  heart.  In  experiments  on  the  detached  frog's  heart,  when 
sufficient  of  the  salt  is  added  to  the  circulating  blood  to  cause  arrest  of 
contractility,  this  annulled  property  can  be  restored  by  diluting  the 
blood  with  an  equal  quantity  of  saline  solution,  so  that  the  ventricle  re- 
ceives the  same  quantity  of  the  salt,  but  in  a  more  diluted  form. 

These  facts  elucidate  the  meaning  of  the  experiment  of  injecting  a  large 
dose  into  the  jugular  vein,  so  that  the  salt  reaches  the  heart  in  a  con- 
centrated condition,  and  arrests  its  action,  whilst  the  same  dose  injected 
at  a  distance  from  the  heart,  so  that  it  becomes  freely  diluted  with  blood, 
does  not  depress  that  organ,  or  at  least  in  a  very  small  degree. 

In  poisoning  by  such  salts  it  is  evident  that  the  treatment  should 
consist  of  free  drinking  to  dilute  the  blood,  and  also  to  promote  elimina- 
tion by  the  kidneys  and  skin.     Bleeding,  too,  should  be  of  some  service. 

These  remarks  merely  mean  that  after  absorption  all  potash  salts  ap- 
pear to  be  equally,  or  nearly  equally,  poisonous  to  the  nervous  and  mus- 
cular tissues,  affecting  first  the  brain  and  central  nervous  system,  next  the 
nerves,  and  lastly  the  muscles.     But  clinical  experience  abundantly  shows 


lOG  POTASSIUM   AND    SODIUM   SALTS. 

that  some  potash  compounds  are  far  more  harmful  than  others.  The 
most  injurious  are  alkaline  in  reaction,  and  produce  a  depressing  effect 
through  the  stomach,  for  at  fii'st  alkalies  increase  the  secretion  of  gastric 
juice,  but  if  too  long  persisted  in  they  disorder  the  mucous  memhrane,. 
and  so  diminish  its  digestive  powers.  In  many  investigations  with  potas- 
sium salts  the  results  have  been  undoubtedly  due  entirely  to  the  potassium, 
tlie  acid  radicle  not  playing  any  part  in  the  results;  and  this  statement 
holds  particularly  with  bromide  of  potassium. 


IODIDE   OF   POTASSIUM.  107 


IODIDE   OF  POTASSIUM,  IODIDE  OF  SODIUM,  AND   IODIDE 

OF   AMMONIUM. 

Iodide  of  potassium  being  an  extremely  soluble  salt,  endowed  witli  a 
very  high  diffusion-power,  finds  ready  entrance  into  the  blood,  and  speedy 
exit  from  it  with  the  secretions  of  the  body. 

As  an  external  application  it  formerly  enjoyed  more  favor  than  is 
accorded  to  it  now.  As  an  ointment  to  the  skin  over  enlarged  glands, 
or  joarts  thickened  with  inflammatory  products,  in  conjunction  with  the 
internal  use  of  iodide  of  potassium,  it  hastens  the  resolution  of  obstinate 
nodes,  and  is  especially  useful  when  the  internal  use  of  this  salt  disa- 
grees, causing  nausea,  diarrhoea,  or  great  prostration.  The  ointment  is 
sometimes  used  for  the  itch,  and  the  ointment  of  this  salt,  or  of  iodine, 
is  often  used  in  bronchocele. 

According  to  most  authorities  the  iodide,  probably  after  its  absorption 
into  the  blood,  produces  decided  changes  in  the  mucous  membrane  of 
the  mouth,  causing  redness  and  injection  of  the  lining  of  the  cheek,  the 
throat,  soft  palate,  and  of  the  tongue,  and  an  increased  growth  and  sep- 
aration of  the  epithelium  covering  these  parts,  and  an  augmented  flow 
of  saliva.  These  phenomena,  however,  are  certainly  often  absent  after 
large  doses  of  the  medicine,  and  even  in  severe  iodism. 

A  j)atient  told  me  that  he  had  tried  spirone  for  asthma,  but  could 
not  continue  it,  as  it  produced  in  his  throat  a  disagreeable  sensation, 
just  like  that  induced  by  potassium  iodide.  He  was  convinced  it  con- 
tained an  iodide;  and  on  testing  spirone  with  Mr.  Martindale  in  his 
laboratory,  we  found  abundance  of  iodine,  and  Dr.  Paul  gave  us  the  fol- 
lowing result  of  his  analysis:  Glycerine,  about  24  per  cent.,  about  2  per 
cent,  of  potassium  iodide,  whilst  nearly  half  its  volume  consisted  of  ace- 
tone. In  one  case  of  bronchitic  asthma  I  tried  a  2  per  cent,  solution  of 
potassium  iodide  as  a  spray,  using  about  a  drop  diluted  with  water, 
thrice  daily.  It  greatly  relieved  the  patient  during  her  attacks,  and 
seemed  quite  as  efficacious  as  Ilimrod's  powder,  whilst  its  effects  seemed 
more  permanent  than  the  powder  or  than  the  iodide  of  methyl,  which 
is  also  useful  in  paroxysms,  acting  in  part  no  doubt  through  its  iodine 
constituent. 

A  large  dose  irritates  the  stomach  and  disorders  digestion.  Some 
are  far  more  prone  than  others  to  be  thus  affected,  so  prone  that  even 
minute  medicinal  doses  sometimes  irritate  the  stomach. 

Like  the  chloride  of  sodium  and  chloride  of  ammonium  this  salt  in- 
creases the  production  of  mucus  from  the  stomach  and  intestines,  as  well 
as  from  the  mucous  membrane  of  other  parts  of  the  body;  but  when  this 
result  is  intended  we  resort  to  the  chloride  of  ammonium  in  preference 
to  this  salt. 

Its  great  diffusion-power  enables  it  to  pass  with  great  rapidity  from 
the  stomach  into  the  blood,  and  it  very  speedily  appears  in  the,  urine,  so 
that  only  a  small  proportion  passes  into  the  intestines.  It  purges  only 
when  taken  in  very  large  doses,  but  it  is  never  employed  for  this  purpose. 

Some  maintain  that  when  iodide  of  potassium  comes  in  contact  with 
the  chloride  of  sodium,  either  in  the  stomach  or  blood,  it  changes  its 
base,  becoming  iodide  of  sodium.  At  present  we  know  but  little  what 
physical  or  chemical  changes  it  produces  in  the  blood,  or  in  the  organs 
to  which  it  is  carried. 

If  its  administration  is  continued  for  a  long  period,  or  if  the  patient 


108  IODIDE    OF   POTASSIUM. 

manifests  great  susceptibility  to  its  action,  we  may  produce  a  condition 
termed  iodism. 

Many  persons  can  take  this  drug  in  very  large  quantities  for  an  almost 
indefinite  time,  without  the  induction  of  iodism,  while  very  small  doses, 
even  of  a  grain  or  part  of  a  grain,  produce  it  in  others. 

The  tissues  most  frequently  and  most  severely  influenced  by  this  drug 
are  the  mucous  covering  of  the  eyes  and  lining  of  the  nose,  frontal  sinus, 
and  mouth,  with  the  skin  of  the  face.  Some  slight  running  at  the  nose  is 
first  noticed,  with  occasional  sneezing,  and  a  little  frontal  headache;  these 
symptoms  becoming  more  marked  when  the  conjunctiva  becomes  injected, 
and  the  tears  flow  abundantly.  The  loose  tissues  about  the  orbit  become 
swollen,  reddened,  and  oedematous,  and  occasionally  a  peculiar  rash  ap- 
pears on  the  skin  of  the  face,  at  first  noticed  around  the  eyes,  after  wliicli 
it  attacks  the  nose  and  its  neighboring  parts,  and  then  the  chin.  The 
parts  in  the  order  here  stated  are  severally  most  severely  affected.  The 
nose  is  sometimes  reddened,  especially  at  the  tip,  and  is  rather  swollen. 
The  rash  does  not  always  present  the  same  appearance.  It  is  often  very 
much  like  acne,  and  is  always  hard,  shotty,  and  indurated,  but  the 
papules  may  be  broad  and  large,  and  covered  with  what  looks  like  a  half- 
developed  vesicle  or  i:)ustule.  The  changes  in  the  mouth  have  already 
been  mentioned  when  speaking  of  the  influence  of  this  medicine  on  that 
part.  With  some  persons  the  stomach  is  at  the  same  time  deranged, 
although  in  the  author's  experience  this  organ  often  escapes  when  the 
face  is  affected;  on  the  other  hand,  the  stomach  sometimes  suffers  when 
the  nose  and  eyes  are  unaffected.  When  the  stomach  is  singled  out  by 
the  iodide,  it  induces  nausea,  and  a  sensation  of  sinking  at  the  epigastrium, 
with  loss  of  appetite,  and  sometimes  water}^  diarrhoea.  A  grain  or  even 
less  may  thus  affect  the  stomach. 

If  the  drug  is  discontinued  on  the  occurrence  of  iodism  the  symptoms 
just  described  speedily  disappear;  and  the  rash  on  the  face,  the  running 
at  the  eyes,  etc.,  will  greatly  decline  in  the  course  of  twenty- four  to  forty- 
eight  hours. 

Iodides  sometimes,  as  I  shall  show  presently,  cause  diuresis.  In  some 
persons  iodides  produce  a  petechial  rash,  affecting  almost  always  the  leg 
exclusively,  rarelv  extending  above  the  knee,  and  rarer  still  to  the  trunk 
or  upper  extremities.  It  may,  at  first,  take  several  days  to  produce  this 
rash,  but  when  the  spots  have  disappeared  a  single  dose  of  five  grains  may, 
in  three  hours,  suffice  to  reproduce  it.  Sometimes  on  persisting  Avith  the 
medicine  no  fresh  rash  appears,  and  the  old  spots  die  away;  wliile  in  otlier 
cases  the  rash  endures  as  long  as  the  medicine  is  continued.  This  rash 
may  be  the  only  apparent  effect  of  the  iodide,  but  it  is  generally  accom- 
panied in  a  variable  degree  by  a  few  or  many  of  the  symptoms  of  iodism. 
The  salts  of  iodine  differ  with  respect  to  the  production  of  this  rash;  thus 
in  many  cases  the  ammonium  salt  is  most  apt  to  induce  it,  and  the  sodium 
salt  the  least  liable:  in  other  cases,  where  the  ammonium  and  potassium 
salts  produce  a  large  crop  of  petechite,  the  sodium  salt  is  inoperative. 
Some  persons  are  equally  affected  by  each  of  these  three  preparations.  In 
one  case,  while  the  ammonium  and  potassium  salts  produced  numerous 
petechige,  the  sodium  salt  failed  to  do  so,  but  excited  on  the  arms  some 
erythema  marginatum.  The  petechial  rash  is  often  preceded  by  a  sensa- 
tion of  heat,  accompanied  by  some  tenderness.  These  facts  seem  to  dis- 
prove the  assertion  that  either  in  the  intestines  or  in  the  l)lood  all  iodides 
ultimately  become  iodide  of  sodium.     A  patient  some  years  after  suffering 


IODIDE    OF    POTASSIUM. 


109 


from  a  white  leg  took  iodide  of  potassium  on  three  separate  occasions; 
each  time  an  abundant  crop  of  petechia  appeared  below  the  knee  of  the 
damaged  leg,  whilst  none  appeared  on  tlie  other  leg. 

Iodide  of  potassium  sometimes  produces  distressing  depression  of  mind 
and  body,  rendering  the  patient  irritable,  dejected,  listless,  wretched,  and 
unable  to  take  moderate  exercise  without  fatigue,  and  perhaps  with  a  ten- 
dency to  fainting.  The  appetite  is  generally  very  bad.  These  symptoms 
may  arise  from  a  very  small  dose,  and  may  occur  without  coryza  or  irrita- 
tion of  the  stomach — a  fact  important  to  bear  in  mind,  otherwise,  the 
cause  of  the  depression  being  overlooked,  the  medicine  may  be  persisted 
in.  On  discontinuing  the  drug  these  distressing  symptoms  disappear  in 
one  or  two  days.  It  now  and  then  exceptionally  happens  that  the  symp- 
toms just  described  sometimes  cease  in  a  few  days,  even  though  the  patient 
goes  on  taking  the  medicine. 

When  the  potassium  salt  is  not  tolerated  the  ammonium  or  sodium 
salt  can  sometimes  be  borne.  Thus  iodide  of  potassium  in  ten-grain  doses, 
thrice  daily,  produced  so  much  headache,  sneezing,  and  running  at  the 
nose,  that  it  could  not  be  continued,  whilst  the  same  dose  of  iodide  of  sodium 
was  easily  borne,  causing  no  headache,  and  only  a  little  running  at  the 
nose. 

A  full  dose  of  carbonate  of  ammonia' or  spirits  of  ammonia  given  with 
the  iodide  of  potassium  will,  it  is  said,  obviate  these  symptoms  of  iodism; 
but  though  I  have  many  times  put  this  recommendation  to  the  test,  1 
have  seen  no  decided  results,  although  perhaps  the  ammonia  did  occa- 
sionally somewhat  control  the  iodism. 

Arsenic  will  lessen  or  prevent  the  eruptions  produced  by  iodides. 
Dr.  Phillips,  of  St.  Mary's  Hospital,  reports  the  case  of  a  patient  who  took 
fifteen  grains  of  potassium  iodide  thrice  daily,  which  produced  marked 
generarpurpura,  and  he  found  the  addition  of  five  minims  of  liquor 
arsenicalis  to  each  dose  quite  removed  the  petechia  rash,  which,  however, 
returned  on  discontinuing  the  arsenic,  and  again  disappeared  on  resum- 
ing it.  He  tested  the  effect  of  arsenic  four  times  on  this  patient,  and 
each  time  removed  the  petechife. 

Ten  grains  of  iodide  of  potassium  taken  at  bedtime  often  cuts  short 
an  acute  cold  in  the  head,  especially  at  the  onset.  It  is  much  less  effica- 
cious if  the  cold  attacks  the  lungs  also,  and  in  influenza  it  appears  to  be 
useless.  In  ten-grain  doses  several  times  a  day  it  is  said  to  cure  that 
troublesome  and  obstinate  affection,  violent  paroxysmal  sneezing  (see 
Arsenic).  It  is  likewise  useful  in  chronic  colds  in  the  head  in  two  or 
three-grain  doses  thrice  daily.  Iodide  of  potassium  is  very  useful  in 
chronic  bronchitis,  and  may  be  profitably  given  with  chloride  of  ammo- 
nium, both  drugs  first  increasing  the  amount  of  expectoration  and  making 
it  less  viscid.  Five  grains  of  potassium  iodide,  half  a  grain  of  tartar 
emetic,  iin  ounce  of  syrup  of  orange  peel  and  three  ounces  of  water  make 
an  excellent  mixture  in  teaspoonf ul  hourly  doses  in  acute  febrile  catarrh 
of  the  respiratory  tract.  It  is  especially  serviceable  for  children;  the 
tartar  emetic,  acting  very  like  aconite,  induces  a  copious  jDerspiration. 

The  iodide  is  employed  in  a  great  variety  of  diseases.  It  is  largely 
employed  in  syphilis,  but  is  not  equally  efficacious  in  all  its  forms,  being 
more  useful  in  secondary  and  tertiary  syphilis,  especitilly  in  the  tertiary 
form,  where  mercury  may  do  harm.  The  iodide  should  be  employed 
when  the  health  is  broken,  when  mercury  has  been  taken  without  good 
results,  or  when  the  bones  are  diseased.     It  is  conspicuously  beneficial 


110  IODIDE    OF    POTASSIUM 

when  the  disease  fixes  on  the  periosteum  of  the  bones  or  fibrons  structure 
of  the  softer  organs  and  forms  nodes.  Its  action  on  this  form  of  the  disease 
isahnost  magical;  it  soon  subdues  the  pain,  and  the  nodes,  if  not  of  hnig 
standing,  quickly  disappear.  In  the  treatment  of  tubercular  syphilitic 
skin  eruptions  Dr.  Neligan  prefers  it  to  a  salt  of  mercury.  The  iodide  of 
potassium  is  of  very  great  service  in  syphilis  of  deep-seated  and  important 
organs.  It  has  been  commended  in  syphilitic  iritis;  but  in  this  case  most 
authorities  prefer  mercury.  The  secondary  syphilis  of  children  is  best 
treated  with  mercury;  yet  the  following  somewhat  rare  form  of  syphilis 
gives  way  best  to  iodine.  In  children  a  few  months  or  years  old,  a  syphi- 
litic thickening  of  the  periosteum  is  sometimes  observed,  usually  attacking 
the  heads  of  several  of  the  long  bones,  and  sometimes  also  tlie  shafts. 
The  thickening  is  first  felt  around  the  bones;  but  as  the  disease  advances 
the  neighboring  soft  tissues  become  infiltrated  with  a  firm  exudation, 
which  may  increase  to  such  a  degree  that  the  implicated  jiart  of  the  limb 
becomes  much  swollen,  the  skin  very  tense  and  shining,  and  a  little  red- 
dened. The  affected  parts  are  very  painful.  When  the  disease  is  seated 
at  the  head  of  the  bones  the  movement  of  the  joint  is  not  impaired.  If 
long  uncured,  this  condition  leaves  behind  it  permanent  thickening  and 
enlargement;  and  so  we  sometimes  see  children  with  syphilitic  teeth,  and 
blind  from  syphilitic  iritis,  with  considerable  enlargement  of  the  heads 
of  several  of  the  long  bones. 

Certain  non-syphilitic  periosteal  thickenings  yield  likewise  to  this 
remedy. 

The  iodide  of  potassium  has  been  recommended  in  mercurial  saliva- 
tion. 1  agree  with  those  observers  who  believe  that  iodide  of  potassium 
often  aggravates  mercurial  salivation;  though  the  iodide  sometimes  ap- 
pears to  be  undoubtedly  Ijeneficial. 

As  the  action  of  the  iodide  on  the  mercury  in  the  system  throws  much 
light  on  this-  question  we  will  now  shortly  discuss  it.  The  mercury  salts, 
like  those  of  most  other  metals,  form  insoluble  compounds  with  albumin- 
ous substances.  These  compounds  are  very  generally  soluble  in  the 
chlorides,  bromides  and  iodides  of  the  alkalies,  but  especially  in  the 
iodides.  Many  metals,  amongst  others  mercury  and  lead,  are  deposited 
from  the  blood  in  an  insoluble  form,  in  the  animal  structures,  and  iodide 
of  potassium,  by  re-dissolving  either  of  these  two  metals,  brings  one  or 
the  other  again  into  the  circulation,  and  so  re-subjects  the  system  to  its 
influence.  But  then  iodide  of  potassium  will  promote  the  separation  of 
both  mercury  and  lead  by  the  urine,  and  thus  help  to  free  the  system 
from  their  pernicious  effects. 

It  has  been  said  that  iodide  of  potassium  will  dissolve  mercury  com- 
pounds of  albumen  in  the  body,  and  bring  them  back  into  the  circulation; 
and  herein  we  have  the  explanation  of  a  Avell-known  property  of  this  salt, 
namely,  that  of  producing  salivation  in  persons  who  had  previously  taken 
a  considerable  quantity  of  mercury.  After  taking  mercury  for  some 
time,  if  a  patient  had  then  become  salivated,  it  would  naturally  be  antici- 
pated that  iodide  of  potassium  would  still  further  increase  the  ptyalism, 
and  not  check  it.  In  other  cases  it  might  happen  otherwise;  for  we  have 
seen  that  the  salt  will  affect  the  separation  of  this  metal  through  the  urine. 
In  a  case,  therefore,  where  but  little  mercury  has  been  taken,  during  only 
a  short  time,  yet  sufficient  to  produce  salivation,  the  iodide  of  potassium, 
by  quicklv  separating  the  metal  from  the  system,  would  remove  the  mer- 
curial symptoms,  including  the  salivation.     Should  it  ultimately  prove 


IODIDE    OF   POTASSIUM.  HI 

that  the  increased  elimination  is  due  to  the  mercury  being  bronght  back 
into  the  circulation,  and  so  under  the  influence  of  the  kidne^-s,  and  that 
the  iodide  does  not  promote  the  exit  of  the  metal  in  any  other  way,  then 
the  iodide  must  be  simply  harmful  in  mercurial  salivation. 

It  has  been  said  that  this  salt  of  itself  will  produce  salivation,  an  effect 
which  has  been  ascribed  to  the  action  of  the  iodide  on  the  mercury  in  the 
way  Just  explained;  others  hold,  even  where  no  mercury  has  been  taken, 
that  the  iodide  of  potassium  itself  increases  the  salivary  secretion  to  a 
variable  amount  in  different  persons. 

The  unequalled  efficacy  of  iodide  of  potassium  in  eliminating  lead  from 
the  system  through  the  urine  has  led  to  the  employment  of  this  drug  in 
lead-poisoning.  Further  on,  when  treating  of  lead,  it  will  be  shown  how, 
by  virtue  of  its  power  of  eliminating  this  metal,  iodide  of  potassium  may 
prove  itself  useful  in  certain  forms  of  gout. 

It  is  of  signal  service  in  bronchocele,  when  the  enlargement  of  the 
thyroid  gland  is  due  to  hypertrophy,  not  to  cystic  formations,  or  to  other 
causes.  Its  internal  employment  is  often  supplemented  by  painting  the 
swelling  with  the  tincture  or  liniment  of  iodine.  Iodide  of  potassium  is 
used -too  in  either  induration  or  enlargement  of  the  glands,  as  of  the 
mamma  or  testicle,  though  with  less  advantage  than  in  bronchocele. 

The  iodides  quicken  the  absorption  of  inflammatory  effusion,  such  as 
occurs  in  pleurisy  and  in  inflammatory  thickening  of  organs.  Iodide  of 
potassium  sometimes  relieves  sciatica  and  lumbago,  although  it  very  often 
fails  to  affect  either,  especially  sciatica,  even  when  the  pain  is  worse  at 
night. 

Iodide  of  potassium  sometimes  benefits  chronic  rheumatism,  chronic 
rhciimatic  arthritis,  chronic  gout,  especially  the  two  former  affections. 
It  should,  however,  always  be  borne  in  mind  that  the  pains  of  secondary 
syphilis,  frequently  resembling  in  all  respects  those  of  so-called  chronic 
rheumatism,  are  frequently  confounded  Avith,  and  included  among,  the 
manifold  affections  termed  chronic  rheumatism.  Some  of  the  so-called 
cases  of  rheumatism  relieved  by  iodide  of  potassium  are  probably  cases  of 
syphilis. 

The  pains  which  yield  to  iodide  of  potassium  are  mainly  those  marked 
by  nocturnal  increase  of  suffering,  a  symptom  which  may  be  accepted  as 
a  strong  indication  for  the  employment  of  this  medicine — an  indication 
holding  true,  whether  the  pains  are  referable  to  rheumatism  or  to  some 
other  source.  Syphilitic  pains,  it  is  well  known,  are  generally  worse  at 
night,  and  so  are  the  pains  of  many  cases  of  chronic  rheumatism;  now, 
the  iodide  generally  benefits  these  rheumatic  cases. 

Iodide  of  potassium  is  sometimes  singularly  useful  in  peptic  and  bron- 
chial asthma.  Five  grains  or  more,  three  times  a  day,  may  be  required. 
Kow  and  then  its  good  effect  is  not  manifested  for  some  time,  though 
possibly  in  such  a  case  larger  doses  would  bring  prompter  relief.  The 
late  Dr.  Hyde  Salter,  whilst  admitting  the  great  efficacy  of  this  salt  in 
some  instances,  was  inclined  to  think  that  in  the  majority  of  cases  it  is 
useless.  JVIy  limited  experience  leads  me  to  think  it  more  frequently 
useful  than  Dr.  Salter  was  willing  to  admit. 

Iodide  of  potassium  has  sometimes  obviated  barrenness,  presumably 
due  to  syphilis.     Many  employ  it  to  lessen  the  secretion  of  milk. 

Iodide  of  potassium  occasionally  acts  as  a  powerful  diuretic  in  Bright's 
disease.  I  have  seen  it  remove  all  the  dropsy  in  thoroughly  water-logged 
patients,  every  part  of  the  body  being  oedematous,  the  legs  swollen  till 


112 


IODIDE    OF    POTASSIUM. 


thoy  could  not  bo  bent,  the  skin  sliiny  from  distention,  and  the  abdomen 
distended  with  fluid.  The  iodide  increased  tlie  scanty  urine  from  a  few 
ounces  daily  to  30,  then  50,  GO,  and  120  ounces,  till  the  dropsy  disap- 
V)eared,  every  vestige  of  it,  in  a  fortnight.  While,  however,  this  drug 
increased  the  urinary  Avater  and  removed  the  dropsy,  it  produced  very  little 
effect  on  the  amount  of  albumen.  Of  course,  in  proportion  to  the  in- 
creased quantity  of  urine,  the  relative  amount  of  albumen  diminished; 
but,  in  fact,  the  albuminous  urine  is  simply  more  diluted,  and  in  estima- 
ting the  amount  of  albumen  separated  in  the  day,  we  must  bear  in  mind 
the  amount  of  urine  voided.  For  instance,  if  a  patient  is  passing  only 
ten  ounces  daily,  and  on  boiling  the  urine  the  coagulated  albumen  occupies 
half  the  tube,  if  then  the  urine  is  increased  to  twenty  ounces,  the  coagu- 
lated albumen  Avill  occupy  only  a  quarter  of  the  tube,  although  the  quan- 
tity of  albumen  separated  remains  the  same.  Where  the  iodide  proved 
so  useful,  I  at  one  time  thought  the  patient  had  suffered  from  syphilis 
of  the  kidneys,  and  that  the  drug,  removing  this  disease,  the  kidneys  re- 
covered their  lost  power  and  eliminated  the  dropsical  fluid.  In  some  of 
my  cases,  however,  there  was  no  reason  to  conclude  that  the  patients . 
were  syphilitic;  the  disease,  in  some  cases,  following  scarlet  fever,  in 
others  it  appeared  to  be  due  to  cold.  Like  other  diuretics,  as,  for 
instance,  resin  of  copaiba,  its  action  is  very  uncertain.  In  many  cases, 
in  most  indeed,  the  iodide  fails  altogether;  but  this  uncertainty  can  in 
part  be  ex|)lained ;  thiis  a  moderate  dose  of  from  five  to  ten  grains  will  act 
powerfully  with  a  certain  number  of  patients,  whilst  in  others  the  dose 
must  be  very  large.  In  one  case  I  did  not  obtain  its  diuretic  action  till  I 
gave  one  hundred  grains  daily,  and  even  this  dose  had  to  be  increased  to 
two  hundred  daily  to  maintain  the  effect  and  eliminate  all  the  dropsy. 
Now,  in  most  patients,  large  doses  bring  on  severe  iodism  and  depression, 
so  that  probabfy  the  diuretic  dose  cannot  be  reached.  In  my  experience, 
iodide  of  potassium,  like  digitalis,  ceases  to  act  as  a  diuretic  Avhen  the 
dropsy  disappears. 

Dr.  Balfour  recommends  in  aneurism  iodide  of  potassium  from  five 
to  thirty  grain  doses  continued  for  a  considei'able  time,  even  for  tAvelve 
months,  conjoined  with  the  recumbent  posture  and  a  restricted  diet;  and 
he  narrates  several  cases  strikingly  confirmatory  of  the  efficacy  of  this 
mode  of  treatment.  Dr.  Chuckerbutty  supports  his  statements.  I,  too, 
have  seen  on  several  occasions  large  doses  of  the  iodide  of  potassium 
afford  prompt  relief  in  the  severe  pain  from  aneurism;  the  drug  presum- 
ably acts  by  lessening  both  the  size  of  the  tumor  and  its  pressure  on  the 
nerves.  In  some  cases  it  is  certain  that  the  tumor  grows  smaller  and  less 
pulsatile.  Patients  sometimes  assert  that  a  slight  discontinuance  of  the 
iodide  of  only  36  to  48  hours  is  always  followed  by  an  increase  in  pain, 
which  ceases  on  returning  to  the  remedy.  Large  doses  are  sometimes  re- 
quired.    130  grains  or  more  daily  may  be  necessary  to  afford  relief. 

It  probably  acts  partly  by  depressing  the  heart's  action  and  so  lessen- 
ing pressure  in  the  aneurism  and  partly  by  some  direct  action  on  the 
dilated  vessel.  As  aneurisms  often  occur  in  syphilitic  jiersons,  the  drug 
may  in  some  cases  act  antisyphilitically,  but  certain  it  is  that  in  cises 
quite  free  from  syphilis  it  is  highly  beneficial. 

Dr.  Huchard  claims  to  have  cured  twenty  cases  of  angina  i^ectoris  by 
the  administration  of  fifteen  to  thirty  grains  of  sodium  iodide  daily.  11  (^ 
considers  angina  to  be  an  affection  of  the  arteries,  inflammatorv  in 
nature,  and  he  maintains  that  iodide  of  sodium  y\\]\  cure  this  condition 


IODIDE   OF   POTASSIUM.  113 

if  employed  early  enough,  by  obviating  narrowing  of  the  origin  of  the 
coronary  vessels. 

Iodine  has  been  detected  in  the  blood,  saliva,  milk,  and  urine,  even 
in  the  urine  of  the  sucking  child,  whose  mother  was  taking  iodide  of  potas- 
sium. Its  great  diffusion-power  renders  it  probable  that  it  might  be  de- 
tected in  all  the  fluids  bathing  the  tissues  or  moistening  the  cavities.  It 
appears  in  a  few  minutes  in  the  urine,  and  still  more  rapidly  in  the  saliva. 
The  rapidity  of  its  absorption  is  of  course  influenced  by  the  state  of  the 
stomach  and  vascular  system,  the  absorption  occurring  more  slowly  when 
these  are  replete.  The  statements  concerning  its  influence  on  the  various 
constituents  of  the  urine  are  so  discrepant,  and  the  observations  made  on 
the  subject  are  so  imperfect,  that  at  present  our  knowledge  in  this  respect 
must  be  considered  untrustworthy.  It  is  rapidly  separated  from  the  body, 
and,  even  after  large  doses,  soon  becomes  indefectible  in  the  urine;  indeed, 
after  withholding  the  drug,  every  trace  of  it  may  vanish  in  less  than 
twenty-four  hours.  It  is  stated,  on  doubtful  grounds,  that  it  may  be  de- 
tected in  the  saliva  some  days  after  it  has  ceased  to  appear  in  the  urine. 

Some  writers  hold  that  iodide  of  potassium  given  in  large  doses  for 
long  periods  may  produce  albumen  in  tlie  urine,  and  even  Bright's  disease. 

Atkinson  finds  that  iodide  of  potassium  often  causes  oxalates  to  appear 
in  the  urine. 

It  is  said  that  in  Bright's  disease  iodides  are  not  eliminated  by  the 
kidneys;  and  Duckworth  found  their  appearance  in  the  urine  delayed  for 
an  hour  or  longer. 

Five  grains  three  times  a  day  is  generally  a  sufficient  dose.  Some- 
times, as  in  rheumatoid  arthritis,  and  in  syphilis,  no  benefit  is  obtained 
until  much  larger  quantities,  or  ten,  fifteen,  or  even  twenty  grains  are 
given  at  a  dose. 

Large  doses  arrest  the  rapid  sloughing  of  certain  syphilitic  sores  and 
promote  the  healing  process.  Full  doses  sometimes  succeed  when  smaller 
ones  fail. 

For  the  removal  of  syphilitic  nodes  from  the  membranes  of  the  brain 
five  to  ten  grains,  repeated  three  times  a  day,  is  generally  sufficient.  At 
first  the  drug  sometimes  intensifies  the  pain,  then  the  disease  rajndly 
declines.  In  no  other  affection  does  this  medicine  yield  such  striking 
results. 

Iodide  of  potassium  may  be  conveniently  administered  in  milk. 


114  BROMIDE    OF    roTASSITM. 


BROMIDE   OF   POTASSIUM,   SODIUM,  AMMONIUM,   AND 

LITHIUM. 

These  salts  in  physical  and  chemical  properties  are  closely  allied  to 
the  corresponding  iodides;  yet  in  their  action  on  the  body,  the  bromides 
and  iodides  severally  exhibit  considerable  differences. 

The  persevering  use  of  bromides  occasionally  produces  an  acneform 
rash,  and  even  boils.  Yet  Dr.  Cholmeley  reports  the  cure  of  some  obsti- 
nate cases  of  acne  by  moderate  doses  of  bromide  of  potassium. 

Bromide  of  potassium,  in  five  parts  of  glycerine,  has  proved  useful,  it 
is  said,  as  a  local  apj^lication  to  ease  pain  in  hemorrhoids,  fissure  of  the 
rectum,  and  in  painful  growths. 

If  taken  in  moderate  doses  for  some  time,  or  in  larger  doses  for  a 
shorter  time,  bromide  of  potassium  diminishes  the  sensibility  of  the  soft 
palate,  uvula,  and  upper  jjortiou  of  the  pharynx,  as  evidenced  by  the  ab- 
sence of  movement  in  these  parts  when  they  are  touched.  Zoepffel  finds 
that  bromide  of  potassium  affects  the  reflex  irritability  but  not  the  sensi- 
bility of  the  pharynx;  thus, after  its  use,  irritation  of  the  throat  will  not 
excite  deglutition,  but  the  pain  of  operations  is  not  lessened.  He  agrees 
with  Voisin,  that  thirty  grains  may  be  insufficient  to  affect  the  pharynx, 
and  that  sometimes  it  may  be  necessary  to  repeat  this  dose  two  or  three 
times,  a  few  hours  apart.  It  has  been  recommended  to  give  the  bro- 
mides to  reduce  the  excitability  of  the  throat  preparatory  to  a  laryngo- 
scopical  examination;  and  it  is  even  averred  by  some  writers  that  merely 
brushing  the  pharynx  and  soft  palate  with  a  solution  of  the  bromide  is 
sufficient  to  quell  the  irritability  and  to  permit  a  laryngoscopic  examina- 
tion with  comfort  to  the  patient.  Many  observers,  however,  question 
this  use  of  bromide,  and  Dr.  Mackenzie  considers  that  ice  is  more  effica- 
cious; a  cocaine  solution  or  spray  of  five  per  cent,  strength  aj)2:)lied  to 
the  throat  is  very  efficacious. 

Assuming  that  the  bromides  possess  the  property  of  diminishing  the 
sensibility  or  the  reflex  irritability  of  the  pharynx,  it  was  naturally  sur- 
mised that  they  would  lessen  the  excitability  of  the  larynx,  and  thus 
prove  useful  in  those  diseases  accompanied  by  spasmodic  contraction  of 
the  glottis,  as  whooping-cough  and  laryngismus  stridulus. 

It  is  possible  to  reconcile  the  discrepant  statements  concerning  the 
influence  of  this  remedy  on  these  diseases.  Now,  as  to  whooping-cough, 
all  observers  must  admit  that  some  cases  are  altogether  uninfluenced  by 
this  remedy,  and  that  it  lessens  neither  the  frequency  nor  the  severity  of 
the  paroxysms  of  coughing.  In  other  cases,  it  appears  to  control  both 
the  frequency  and  the  severity.  The  bromide,  I  believe,  will  only  be 
found  serviceable  in  simple  uncomplicated  whooping-cough.  If  there  is 
fever,  or  much  catarrh  of  the  lungs,  if  there  is  i)neumoni;i,  or  tuberculo- 
sis, if  the  child  is  teething,  and  the  gums  are  swollen,  red,  and  painful, 
or  if  any  gastric  irritation  exists,  then  till  these  complications  have  been 
met  by  appropriate  treatment  this  remedy  fails;  but  when  the  case  has 
been  reduced  to  a  simple  form,  the  bromide  of  potassium  does  certainly 
influence  the  disease,  lessening  both  the  frequency  and  severity  of  the  par- 
oxysms. It  is  thus  found  to  be  of  most  service  in  the  summer,  or  when 
the  weather  is  genial  and  mild.  Like  other  remedies  for  Avhooping-cough, 
the  bromides  are  more  efficacious  in  some  epidemics  than  in  others. 

The  efficacy  of  bromide  of  potassium  in  laryngismus  stridulus,  is  sub- 
ject to  conditions  very  similar  to  those  which  limit  its  usefulness  in 


BRO.AIIDE    OF     POTASSIUM.  115 

whooping-cough.  Any  irritution,  as  that  from  teething,  must  be  removed 
before  the  remedy  appears  to  manifest  any  power.  As,  however,  in  cold 
sponging,  we  possess  a  cure  for  laryngismus  stridulus,  ready,  prompt,  effi- 
cient, we  need  not  often  have  recourse  to  the  bromide.    (See  Cold  Bath.) 

The  bromides  are  sometimes  useful  in  whooping-cough,  and  laryngis- 
mus stridulus  when  complicated  with  convulsions.  During  a  paroxysm 
of  laryngismus  stridulus,  or  whooping-cough,  the  obstruction  in  the 
larynx  sometimes  becomes  so  urgent  as  to  induce  very  imperfect  oxida- 
tion of  the  blood,  and  to  cause  partial  asphyxia,  resulting  in  an  attack  of 
convulsions.  Convulsions,  moreover,  are  not  uncommon  in  laryngismus, 
independent  of  as])hyxia,  unaccompanied  with  an  attack  of  crowing,  the 
early  and  less  developed  stage  of  these  convulsive  attacks  being  mani- 
fested in  carpopedal  contractions,  squinting,  etc.  The  bromides  will 
control  the  recurrence  of  these  convulsions,  even  when  the  disease  itself 
is  apparently  otherwise  uninfluenced.  With  regard  to  laryngismus 
stridulus,  cold  sponging  is  generally  sufficient  to  avert  convulsions;  but 
in  cases  where,  from  the  elfects  of  any  irritation,  cold  sponging  is  in- 
effectual, the  bromide  of  potassium  will,  in  most  instances,  avert  the 
convulsions,  thus  obviating  one  of  the  gravest  dangers  of  this  disease. 

The  bromide  of  potassium  will  much  benefit  a  curious  affection  we 
sometimes  meet  with  of  a  child,  which,  from  the  time  of  his  birth,  can 
swallow  solids  with  ease,  yet  is  choked  every  time  he  tries  to  drink.  This 
strange  affection  is  in  no  way  connected  with  diphtheria  or  any  visible 
affection,  or  malformation,  of  the  throat.  The  bromides,  so  far  as  we 
know,  appear  to  have  very  little  influence  on  the  stomach. 

In  certain  cases,  these  salts  exert  a  beneficial  influence  on  the  intes- 
tines; for  instance,  in  a  form  of  colic,  which  sometimes  affects  children 
from  a  few  months  to  one  or  two  years  old.  The  walls  of  the  belly  are 
retracted  and  hard,  while  the  intestines,  at  one  spot,  are  visibly  contracted 
into  a  hard  lump,  the  size  of  a  small  orange,  and  this  contraction  can 
be  traced  through  the  walls  of  the  belly,  travelling  from  one  part  of  the 
intestines  to  another.  These  colicky  attacks,  unconnected  with'  consti- 
pation, diarrhcea  or  flatulence,  occur  very  often,  and  produce  excruciat- 
ing pain.  Sometimes  they  are  associated  with  a  chronic  aphthous  con- 
dition of  the  mouth.  They  generally  resist  all  other  kinds  of  treatment 
but  the  bromides.  Like  the  iodides,  these  salts  pass  quickly  into  the 
blood,  and  we  shall  now  treat  of  their  influence  on  the  organs  to  which 
they  are  conveyed  by  this  fluid. 

The  bromides  lessen  considerably  the  functions  of  the  brain  and  cord. 
Experimentally,  it  is  found  that  in  animals  under  their  influence  irrita- 
tion of  the  motor  centres  of  the  brain  fails  to  excite  convulsions. 

Bromide  of  potassium  is  used  in  a  variety  of  diseases,  but  its  virtues 
are  chiefly  conspicuous  in  convulsions. 

It  is  serviceable  in  all  forms  of  convulsions — in  epilepsy,  in  the  con- 
vulsions of  Bright's  disease,  and  in  the  convulsions  of  children,  whether 
due  to  centric  or  eccejitric  causes.  Albertoni  finds  that  potassium  bro- 
mide given  for  several  weeks  greatly  diminishes  the  excitability  of'  the 
motor  centres  of  the  brain,  so  that  he  could  not  excite  epileptic  convul- 
sions in  dogs  by  irritating  the  cortical  substance. 

In  no  disease  is  the  bromide  of  potassium  more  signally  efficacious 
than  in  epilepsy,  though  it  is  not  equally  useful  in  all  forms,  for  this 
drug  leaves  attacks  ot  petit  vial  often  unbenefited.  It  is  the  convulsive 
form  of  epilepsy  which  is  so  remarkably  amenable  to  the  bromide,  for  in  by 


116  BROMIDE    OF    POTASSIUM. 

far  the  greater  number  of  cases,  tlie  fits,  under  its  influence,  become  much 
less  severe  and  less  frequent.  Even  when  of  great  severity,  and  repeated 
perhaps  several  times  a  day,  the  fit  may  be  postponed  for  weeks,  and 
even  months;  nay  in  some  cases  it  has  been  delayed  for  years. 

Cases  of  the  convulsive  form,  however,  occasionally  occur,  over  which 
the  bromide  apj^ears  to  be  powerless;  the  fits  recurring  as  often  and  as 
severely  as  if  no  medicine  had  been  taken.  Sometimes  when  the  drug 
arrests  the  epileptic  convulsion,  the  patient  becomes  dull,  irritable,  idiotic, 
conditions  which  on  the  recurrence  of  a  fit  are  removed.  Again,  though 
stopping  the  greater  attacks,  bromides  may  increase  the  frequency  of  the 
jMit  mal.  It  is  not  possible  to  foretell  when  the  medicine  will  succeed, 
and  when  it  will  fail.  As  might  be  expected,  the  effects  of  the  drug  are 
most  marked  when  the  disease  is  of  short  standing. 

Dr.  Weir  Mitchell  recommends  bromide  of  lithium  in  epilepsy. 

It  contains  a  larger  percentage  of  bromide  than  either  the  sodium  or 
potassium  salts,  and  it  acts  more  powerfully,  so  that  smaller  doses  mav  be 
given.  Dr.  Mitchell  thinks  the  lithium  salt  succeeds  sometimes  when  the 
potassium  and  sodium  salts  fail.  As  a  hypnotic,  he  says,  "  it  is  superior 
to  the  potassium  and  other" salts  of  bromine."  Echeverria  thinks  it  is  infe- 
rior to  the  potassium  salt  in  epilepsy,  and  as  a  hypnotic  superior  to  the 
sodium  and  calcium  salts. 

Echeverria  considers  the  potassium  salt  much  superior  in  epileps}^  to 
the  ammonium  salt.  The  ammonium  salt  is  more  disagreeable  to  the 
taste.  In  epileptic  maniacal  excitement  Echeverria  finds  bromide  of  sodi- 
um far  less  serviceable  than  bromide  of  ammonium.  He  moreover  asserts 
that  bromides  fail  to  suppress  mental  excitement  in  epileptics  unless  com- 
bined with  some  other  narcotic,  as  conium,  cannabis  indica,  hyoscyamus, 
chloral  (15  to  20  grains  each),  or,  still  better,  ergot  of  rye. 

In  mild  epileptic  cases  ten  grains  three  times  daily  is  sufficient.  AYlien 
the  attack  occurs  only  at  night,  the  best  way  to  avert  it  is  to  give  at  bed- 
time a  full  dose  of  thirty  grains.  Echeverria  finds  that  the  average  dose 
required  is  sixty  grains  daily,  but  in  severe  cases  a  much  larger  quantity 
may  be  needed.  In  respect  to  the  dose,  Voisin  says,  "I  have  emplo3^ed 
for  many  years  a  method  which  has  given  me  the  best  results,  which  con- 
sists in  determining  the  condition  of  reflex  nausea  by  introducing  a  spoon 
as  far  as  the  epiglottis.  I  have  remarked  that  a  therapeutic  dose  of  the 
bromide  of  potassium  is  not  attained  till  reflex  nausea  is  suppressed;  it 
is  not  till  then  that  the  bulb  is  certainly  acted  on,  and  its  excito-motory 

force  diminished The  study  of  other  reflex  phenomena,  such  as 

lachrymation,  cough  and  sneezing,  enables  us  to  follow  the  action  of  the 
medicine  upon  the  bulb  and  spinal  cord.  I'he  dose  should  not  be  increased 
beyond  the  suppression  of  reflex  nausea,  but  it  should  be  given  continu- 
ously for  years  together.  If  the  malady  be  ameliorated,  or  in  process  of 
cure,  at  the  end  of  two  years  of  amelioration,  the  remedy,  instead  of  being 
administered  every  day,  may  be  given  every  second,  third,  or  fourth  day, 
provided  reflex  nausea  be  alway^and  certainly  absent."  Voisin  considers 
that  the  early  manifestation  of  toxic  effects  is  a  good  and  their  late  aiipoar- 
ance  a  bad  augury. 

If  the  patient  is  not  cured,  but  only  benefited,  by  the  bromide,  it  may 
be  continued  for  months  or  years.  But  its  administration  should  l)e  sus- 
pended at  times  for  a  week  or  ten  days,  or  on  two  days  in  each  week,  vsay 
^Monday  and  Thursday,  otherwise  the  system  becomes  accustomed  to  it, 
when  it  loses  its  influence,  so  that  the  good  effects,  so  well  marked  origi- 


BROMIDE    OF    POTASSIUM.  117 

nally,  cease  altogether,  the  fits  recurring  with  their  old  severity  and  fre- 
quency. If  in  such  a  case  the  drug  is  withheld  for  a  time,  and  then  re- 
sumed, it  again  manifests  all  its  previous  etticacy. 

It  has  been  asserted  and  denied  that  chloride  of  potassium  in  epilepsy 
is  as  efficacious  as  bromide  of  potassium. 

We  have  already  spoken  of  the  effect  of  bromide  of  jDotassium  on  the 
convulsions  sometimes  accomjianying  whooping-cough  and  laryngismus 
stridulus.  The  bromide  will  often  prove  useful  in  all  other  diseases  asso- 
ciated with  general  convulsions.  Of  course  the  exciting  cause  of  the 
convulsive  attacks  should,  if  possible,  be  removed;  but  even  when  the 
cause  is  indetectable,  this  salt  will  often  lessen  or  prevent  the  epileptiform 
seizures.  The  convulsions  caused  by  intestinal  worms  sometimes  resist 
this  remedy  completely. 

Bromide  of  potassium  will  often  check  the  convulsions  resulting  from 
simple  meningitis,  when  the  fits  which  sometimes  jjersist  after  the  de- 
cline of  the  inflammation  inflict  serious  damage. 

Many  writers  extol  bromide  of  potassium  in  the  incidents  of  teeth- 
ing, averring  that  it  lessens  pain,  obviates  irritability  and  restlessness, 
and  prevents  convulsions.  Bromide  of  potassium  checks  the  Scilivation 
sometimes  occurring  in  pregnancy,  and  succeeds  sometimes  after  the 
failure  of  atropine  and  pilocarpine.  (Schunn.)  The  bromides  are  most 
valuable  hyjjnotics. 

Voisin,  referring  to  his  patients  in  the  Bicetre,  says,  "The  hypnotic 
action  upon  them  was  very  remarkable  night  and  day.  Some  were  obliged 
to  slee23  for  a  few  minutes  at  a  time  in  the  midst  of  their  work.  Xone, 
in  spite  of  whatever  efforts  they  made  to  the  contrary,  could  resist  sleep 
directly  after  their  evening  meal."  They  have  been  found  of  especial 
use  in  obviating  that  sleeplessness  and  wandering  at  night,  not  unfre- 
quently  occurring  during  convalescence  from  acute  diseases. 

As  a  soporific  bromide  of  potassium  is  especially  useful  in  the  sleep- 
lessness caused  by  worry  or  overwork,  orthat  occurring  at  the  climacteric, 
or  from  menstrual  disturbances.  The  brief  amount  of  sleep  obtained  by 
these  patients  is  often  harassed  by  nightmare,  whilst  the  sleeplessness 
further  depresses  the  nervous  system  and  other  functions,  and  the  pa- 
tients become  still  more  dejiressed  and  irritable  in  temper.  They  are 
excessively  nervous,  and  often  easily  yield  to  crying.  In  such  a  condi- 
tion bromides  at  night,  in  twenty  to  twenty-four  grain  doses,  are  invalu- 
able. They  induce  quiet,  dreamless,  refreshing  sleej),  even  where  tbey 
induce  an  equal  amount  of  sleep.  They  are  greatly  preferable  to  other 
soporifics  or  narcotics,  since  they  do  not  produce  the  ill  effects  on  tlie 
stomach,  liver  or  intestines  that  opiates  induce.  Their  good  effects,  too, 
are  more  marked  than  the  effects  of  other  narcotics,  like  chloral;  so  that 
in  addition  to  their  soporific  action  it  is  fair  to  conclude  that  bromides 
act  beneficially  in  the  conditions  described. 

There  is  a  group  of  symptoms  variously  combined,  occurring  mostly 
in  women,  generally  townspeople.  The  patient  is  very  "nervous,"'  sub- 
ject often  to  great  despondency,  at  times  so  unendurable  as  to  make 
her,  as  she  expresses  it,  feel  as  if  she  should  go  out  of  her  mind.  She  is 
very  irritable,  is  unable  to  fix  her  attention,  and  noises  distress  her.  She 
sleeps  badly,  her  rest  being  broken  by  harassing  dreams.  This  condition 
often  arises  from  overwork,  grief,  worry,  or  too  long  residence  in  town, 
or  want  of  change 


118  BROMIDE    OF     POTASSIUM. 

The  bromide  of  potassium  will  always  cure  this  group  of  symptoms. 
Their  occurrence,  independently  or  associated  with  other  illnesses,  as 
the  change  of  life,  or  migraine  (sick  headache,  nervous  sick  headache, 
bilious  headache),  is  a  distinct  indication  to  give  the  bromide.  In  sucli 
a  case  a  bromide  acts  by  inducing  sleep,  and  so  strengthening  the  nerv- 
ous system. 

The  bromide  has  been  often  extolled  for  its  efficacy  in  the  symptoms 
pertaining  to  the  "  change  of  life  "and  in  migraine,  and  though  often 
very  serviceable,  yet  it  often  fails.  The  distressing  symptoms  occurring 
during  the  change  of  life  are  very  various,  but  generally  occur  in  defi- 
nite groups,  though  these  may  be  more  or  less  combined.  The  group  of 
symptoms  I  have  Just  described  commonly  occurs  at  the  menopause,  and 
yields  almost  always  to  the  bromides.  This  group  is  often  associated 
with  heats  and  flushings,  followed  by  free  perspiration  and  prostration, 
sometimes  extreme.  These  symptoms  too  will  also  generally  give  way 
to  the  bromide.  If,  however,  the  heats,  flushings,  and  perspirations 
predominate  over  the  mental  depression,  nervousness,  irritability  and 
sleeplessness,  then  small  doses  of  nitrite  of  amyl  (see  this  drug)  will  gen- 
erally prove  more  serviceable  than  bromide  of  potassium.  Whilst  re- 
moving the  heats,  flushings  and  perspiration,  the  nitrite  of  amyl  con- 
trols the  other  group  of  symptoms,  quiets  the  nervous  system,  produces 
sound  dreamless  sleep  and  relieves  the  nervousness  and  depression.  At 
the  change  of  life  patients  often  comjilain  of  much  fluttering  at  the 
heart,  a  symptom  best  controlled  b}^  large  doses  of  the  astringent  prep- 
arations of  iron  (see  Iron).  Indeed,  if  a  patient  is  anaemic  the  bromide 
or  indeed  any  treatment,  though  efficacious  for  a  time,  fails  in  the  long 
run.  All  the  troubles  of  the  menopause,  except  sleeplessness,  are  much 
benefited  by  valerianate  of  zinc,  which  may  be  given  thrice  daily  after 
food,  whilst  taking  the  bromide  at  bed  time. 

Occasionally  the  troubles  just  described  yield  but  partially  to  the 
treatment  here  recommended;  or,  if  removed  for  a  time,  they  recur  with 
greater  intensity  and  eventually  become  unendurable.  Then  the  only 
resource  is  thorough  change  of  air  and  scene,  or  travelling  for  three  or 
six  months. 

In  migraine,  too  (sick  headache  and  its  allies),  bromide  of  potassium, 
though  often  of  great  service,  in  many  cases  altogether  fails.  In  the 
article  on  croton  chloral  I  have  treated  of  migraine,  and  here  I  merely 
add  that  we  often  find  the  headache  associated  with  the  group  of  symp- 
toms previously  described,  namely,  nervous  depression,  sleeplessness, 
irritability,  etc.  Perhaps  for  years  previously  the  patient  has  been 
troubled  with  attacks  of  migraine,  at  intervals  of  a  month  or  so.  On 
the  occurrence  of  this  group  of  symptoms  the  attacks  of  migraine  be- 
come much  more  frequent  and  severe;  indeed,  the  pain  may  become 
continuous,  though  at  times,  generally  once  a  day,  it  may  be  paroxys- 
mally  worse.  The  irritability,  sleeplessness,  etc.,  are  indications  of  a 
depressed  nervous  system,  which  accounts  for  the  increased  frequency  of 
the  migrainous  attacks.  With  this  condition  of  the  nervous  system, 
slight  disturbances  and  causes  of  irritation  bring  on  severe  headaches; 
sometimes  so  easily  induced  that  they  occur  daily.  Bromide  of  potas- 
sium produces  refreshing  sleep,  soothes  the  nervous  system,  dispels  the 
other  symptoms,  and  at  the  same  time  lessens  the  frequency  and  severity 
of  the  headaches.     Again,  derangement  of  the  womb  excites  migrainous 


BROMIDE    OF     POTASSIUM.  119 

attacks  either  at  a  normal  or  menorrhagic  period.  Here  again  bromide  of 
potassium  is  useful,  and  its  efficacy,  when  the  attacks  are  caused  by  men- 
orrhagia,  is  not  entirely  due  to  its  checking  this  condition,  for,  given  be- 
tween the  periods,  it  may  improve  the  migraine  before  the  next  attack 
of  menorrhagia.  Whilst  speaking  of  uterine  disturbance  as  an  exciting 
cause  of  these  headaches,  I  may  mention  that  sometimes  they  are  due  to 
uterine  mischief,  generally  of  the  neck  of  the  uterus,  and  remain  rebel- 
lious to  any  treatment  till  the  womb  is  cured  either  by  injections  or  by 
other  treatment. 

Sometimes  during  an  attack  a  full  dose  induces  sleejD,  and  after  a  few 
hours  the  patient  awakens  free  from  headache. 

Sometimes  in  the  later  months  of  pregnancy  a  woman  becomes  at 
night  the  prey  of  the  most  frightful  imaginings,  laboring  under  the  im- 
pr^sion  that  she  has  committed,  or  is  about  to  commit,  some  great  crime 
or  cruelty,  as  the  murder  of  her  children  or  husband.  The  bromide  dis- 
pels these  delusions,  and  induces  calm,  refreshing  sleep.  Freidreich 
gives  15  to  30  grains  daily  for  vomiting  of  pregnancy. 

Bromide  of  potassium  is  of  great  service  in  the  treatment  of  children 
subject  to  night-screaming,  a  symptom  which  appears  to  be  allied  to 
nightmare.  Children  from  a  few  months  to  several  years  old  may  be 
attacked  with  this  affection.  Sometimes  the  attack  occurs  only  once  or 
twice  a  week,  as  is  usually  the  case  with  older  children;  or  it  may  be 
repeated  several  times  each  night.  The  screaming  may  last  only  a  few 
seconds  or  it  may  endure  for  several  hours.  While  screaming,  these 
children  are  generally  quite  unconscious  of  what  is  occurring  around 
them,  and  cannot  recognize,  nor  be  comforted  by,  their  friends.  They 
are  generally  horribly  frightened.  A  somewhat  similar  condition  is  met 
with  in  children  a  few  years  old,  a  state  very  similar  to  somnambulism, 
but  sometimes  apparently  allied  to  epilepsy.  The  child  gets  out  of  bed 
while  fast  asleep,  walks  about  the  house,  and  performs,  as  if  awake,  vari- 
ous acts,  quite  unconsciously.  This  stage  is  not  accompanied  with  any 
terror.  With  the  screaming  and  fright,  squinting  sometimes  occurs, 
which  after  some  time  becomes  permanent.  In  these  cases  bromide  of 
potassium  will  prevent  the  screaming,  and  remove  the  squinting.  This 
affection  in  children  being  connected  very  generally  with  deranged  di- 
gestion, the  condition  of  the  stomach  or  intestines  should  be  attended 
to;  but  even  in  spite  of  this  derangement  the  bromide  will  give  quiet 
and  refreshing  sleep. 

The  nightmare  of  adults  will  generally  yield  to  the  same  medicine. 

Bromide  of  potassium  is  often  of  conspicuous  benefit  in  delirium 
tremens,  removing  the  delusions,  calming  the  delirium,  and  inducing 
sleep,  and  its  efficacy  is  most  apparent  in  the  earlier  stages,  before  the 
delirium  becomes  furious.  Moreover,  it  is  of  great  service  in  dispelling 
delusions  which  may  remain  after  the  partial  subdual  of  the  attack. 

In  delirium  tremens  bromides  often  succeed  where  opium  fails. 

Bromides  will  sometimes  induce  sleep  in  febrile  diseases,  but  in  such 
cases  opium  or  chloral,  or  both  combined,  produce  a  far  more  certain  and 
beneficial  result. 

To  produce  sleep,  twenty  to  thirty  grains  should  be  given  at  night,  and 
should  this  prove  insufficient,  a  like  dose  may  be  taken  in  the  morning. 
Likewise  twenty  to  thirty  grains,  or  even  more,  may  be  given  in  delirium 
tremens  every  two  hours  till  the  patient  falls  asleep. 


120  BROMIDE    OF     POTASSIUM. 

The  bromide  is  soothing  in  hysteria,  gives  patients  greater  self-con- 
trol, and  prevents  h3'sterical  paroxysms. 

It  is  also  used  with  decided  benefit  in  certain  derangements  of  the 
organs  of  generation.  Large  doses  are  said  to  lessen  the  natural  men- 
strual discharge.  In  some  forms  of  menorrhagia  it  is  equal,  if  not  supe- 
rior, to  any  remedy  we  possess;  but  it  is  more  useful  in  the  flooding  of 
young  than  of  old  women.  It  is  very  useful  in  the  case  of  young  women 
Avho  menstruate  too  often  as  well  as  too  copiously.  It  first  regulates  the 
time  of  the  discharge  and  often  lessens  the  amount.  It  is  also  very  serv- 
iceable in  the  floodings  or  too  frequent  menstruation  occurring  at  the 
change  of  life,  and  at  the  same  time  relieves  many  other  of  the  troubles 
incidental  to  the  menopause.  Over  that  form  of  flooding,  due  to  uterine 
tumors  of  various  kinds,  it  exerts  less  control  in  many  cases  than  ergot 
and  some  other  remedies.  To  check  profuse  menstruation,  its  adminis- 
tration must  be  regulated  by  the  circumstances  of  the  case.  If  the  loss 
of  blood  occurs  only  at  the  natural  period,  the  medicine  is  then  com- 
menced about  a  week  before;  and  when  the  menstrual  flux  has  ceased 
the  remedy  should  be  discontinued  till  the  next  attack  is  about  to  begin. 
On  the  other  hand,  when  the  loss  of  blood  occurs  every  two  or  three 
weeks,  or  oftener,  the  medicine  must  be  given  without  intermission  till 
the  loss  is  controlled;  and  wlieu  the  discharge  has  been  brought  to  its 
right  period  and  amount  it  is  still  desirable  to  give  a  few  doses  for  a 
short  time  before  each  monthly  period.  Ten  grains  three  times  a  day  is 
a  dose  sufficient  in  the  flooding  of  young  women,  but  much  larger  doses 
are  required  in  the  more  obstinate  forms  depending  on  organic  changes 
in  the  womb.  This  remedy  has  been  recommended  by  Dr.  Begbie  in 
jiuerperal  mania  and  nymphomania.  Dr.  Clarke  also  says  it  reduces 
sexual  excitement  in  those  instances  of  hysterical  excitement  verging  on 
nymphomania.  Small  doses  are  unavailing.  Twenty  grains,  not  less, 
thrice  daily,  will  exert  a  decided  control  over  excessive  sexual  propensity. 

It  also  restrains  spermatorrhoea.  Its  employment  should  be  supple- 
mented by  cold  sponging  of  the  scrotum  and  perina^um,  and  the  suspen- 
sion of  the  testicles  in  cold  water  for  some  minutes  night  and  morning. 
Seminal  emissions  are  generally  excited  by  dreams,  which  may  often  be 
avoided  by  abstaining  from  suppers,  and  sleeping  on  a  hard  mattress. 
Dr.  George  Bird  has  pointed  out  that  seminal  emissions  occur  from  un- 
due indulgence  in  bed,  the  emissions  taking  place  almost  always  early  in 
the  morning,  during  the  second  sleep.  He  recommends,  therefore,  that 
the  patient  should  be  roused  after  six  or  seven  hours'  sleep,  and  should 
never  give  in  to  a  second  sleep.  The  observance  of  this  simple  means 
will  often  cure  this  otherwise  troublesome  affection.  Dr.  Hardman, 
of  Blackpool,  tells  me  that  he  has  cured  some  obstinate  cases  of  sper- 
matorrhea by  directing  the  patient  to  empty  his  bladder  on  waking 
from  the  first  deep  sleep. 

Bromides  are  useful  in  sea-sickness.  They  should  be  given  three 
times  a  day,  and  be  begun  some  days  before  sailing. 

It  proves  useful  in  allaying  various  forms  of  hyperfesthesia,  and 
sometimes  eases  the  severe  pain  of  chronic  arthritis. 

Dr.  Da  Costa  finds  that  bromide  of  potassium  lessens,  or  even  pre- 
vents, many  of  the  disagreeable  symptoms  of  opium,  as  giddiness,  con- 
fusion of  mind,  fainting,  lieadache,  and  sickness.  It  manifests  this 
effect  over  morphia  and  codia,  less  than  over  laudanum.     A  large  dose 


BROMIDE     OF     POTASSIUM.  121 

— 20  grains — of  bromide  must  be  given  half  an  hour  before  and  two 
days  after  the  laudanum.  Even  larger  doses  are  necessary;  he  even 
gives  40  to  60  grains  some  hours  before  the  administration  of  the 
opium.  Da  Costa  says  the  bromide  exerts  most  control  over  the  faint- 
ness.  He  avers  also  that  the  bromide  heightens  the  "  anodyne  or  hyp- 
notic effects  of  opium."  Bromides,  like  hydromic  acid,  prevent  the 
deafness  and  buzzing  caused  by  salicylate  of  soda  or  quinine;  ten  to  fif- 
teen grains  must  be  added  to  each  dose  of  either  drug. 

If  the  medicine  is  continued  for  a  long  time,  as  is  sometimes  required 
in  the  treatment  of  epilepsy,  the  physiological  effects  of  the  drug  become 
apparent.  "  Diminished  sensibility,  followed  by  complete  anesthesia  of 
the  soft  palate,  uvula,  and  upper  part  of  the  pharynx,  is  tlie  first  symptom 
that  the  patient  is  getting  under  the  influence  of  the  drug.  The  sexual 
organs  are  among  the  first  to  be  influenced,  for  there  is  soon  produced 
failure  of  sexual  vigor,  and,  after  a  time,  marked  diminution  of  the  sex- 
ual appetite  itself."     (liazire.) 

These  effects  vary  greatly;  in  some  the  remedy  jn'oducing  only  moder- 
ate diminution,  in  others,  temporary  impairment.  On  discontinuing  the 
remedy,  the  sexual  organs  regain  their  lost  jjower.  Another  frequent  re- 
sult of  the  prolonged  administration  of  the  bromide  is  an  eruj^tion,  gen- 
erally acnef orm,  occurring  most  on  the  face  and  back,  but  it  may  affect 
even  a  larger  surface.  These  spots  do  not  generally  suppurate,  nor  do 
they  scar.  Echeverria  finds  that  five  to  ten  minims  of  liquor  arsenicalis, 
given  with  the  bromide,  will  prevent  the  eruption,  and  the  experience  of 
the  Epileptic  Hospital  confirms  him;  and  J  have  seen  cases  where  the 
rash  has  been  quickly  removed  and  subsequently  prevented  by  arsenic.  I 
have  found  that  iodide  of  sulphur  ointment,  frequently  applied,  consid- 
erably lessens  the  quantity  and  the  severity  of  these  eruptions.  The  effi- 
cacy of  the  remedy  bears  no  proportion  to  the  amount  of  acne.  The 
hromide  sometimes  excites,  it  is  said,  eczema,  and  spots  like  erythema 
nodosum.  The  acneform  spots  may  become  true  boils,  and  these  boils 
sometimes  form  large  ulcers  with  conical  scabs,  looking  like  rupia.  Dr. 
Weir  Mitchell  narrates  a  case  of  this  kind.  He  found  that  bromides  of 
potassium,  sodium,  ammonium,  and  lithium,  produced  these  ulcers.  He 
tried  also  bromides  of  calcium,  magnesium,  and  bromine  itself,  but  as 
these  preparations  failed  to  control  the  epileptic  fits,  they  were  not  given 
long  enough  to  determine  if  they  too  would  produce  these  rupoid  ulcers. 
Professor  Duhring,  in  addition  to  acneform  pustules,  enumerates  brown- 
ish discoloration  of  the  skin;  simple  papular  eruption;  confluent  or  mol- 
luscoid  acne ;  maculo-papules,  carbuncular  acne,  and  bulle  and  rupia  as 
the  occasional  consequences  of  bromides.  Undue  administration  of  the 
bromides  renders  a  patient  low-spirited,  easily  fatigued,  and  unfitted  for 
work,  and  greatly  lessens  the  brain's  functional  activity,  sometimes  to  a 
very  marked  extent.  It  produces  this  effect,  as  Brunton  remarks,  with- 
out disturbing  the  relation  of  one  part  of  the  brain  to  another.  All 
these  symptoms  soon  subside  on  the  suspension  of  the  medicine. 

Acne,  and  the  other  evidences  of  bromism,  rarely  occur,  unless  more 
than  one  dose,  however  large,  is  taken  daily. 

M.  Rabuteau  says  that  bromide  of  potassium  may  be  detected  in  the 
urine  and  saliva  twenty  days  after  the  administration  of  a  dose  of  fifteen 
grains.  Dr.  Amory  could  not  find  it  more  than  forty-eight  or  fifty-two 
hours  after  a  single  dose,  but  after  the  drug  had  been  taken  several  days. 


122  ACIDS. 

and  then  discontinued,  he  could  find  evidences  of  it  after  a  longer  time. 
Elimination  by  the  urine  is  less  rapid  than  absorption  by  the  stomach. 
Traces  appear  in  the  urine  in  ten  minutes.  Elimination  is  most  active 
during  the  first  eight  or  ten  hours,  and  in  less  than  twenty-four  hours  the 
greater  part  disappears.  It  can  be  detected  in  the  milk  and  sweat. 
Bromide  of  potassium  is  conveniently  administered  in  beer  or  milk. 


A  THEORY  CONCEENING  THE  "  TOPICAL ''  ACTION  OF 
ACIDS  AXD  ALKALIES  ON  SECRETION. 

Previous  to  treating  in  detail  of  acids  and  alkalies,  I  wash  to  note 
their  action  on  the  secretions  of  the  body,  and  to  draw  attention  to  a  theory 
which  I  think  explains  their  action  in  this  resjiect;  moreover,  this 
theory  serves  as  a  useful  guide  to  their  correct  employment  in  disease. 

Acids  are  powerful  stimulants  of  salivary  secretion:  the  impression 
from  the  acid  is  conducted  to  the  spinal  cord,  and  is  thence  reflected 
through  the  cerebro-sj^inal  nerves  supplying  the  salivary  glands;  for 
if  these  are  divided,  acids  cease  to  augment  the  salivary  secretion. 

Repeated  and  careful  ex^ieriments  have  established  the  fact  that  dilute 
acids  taken  into  the  stomach  check  its  secretion;  alkalies,  on  the  other 
hand,  powerfully  excite  the  secretion  of  the  gastric  juice. 

Acids,  then,  check  acid,  but  increase  alkaline  secretions;  while 
dilute  alkalies  stimulate  acid  secretions. 

From  these  facts  the  more  general  law  is  inferred,  that  acids,  applied 
topically,  check  the  j^roduction  of  acid  secretions  from  glands,  while  they 
increase  the  flow  of  alkaline  secretions ;  the  very  reverse  being  the  case 
w'ith  alkalies,  for  alkalies  applied  to  the  orifices  of  glands  with  acid  secre- 
tions increase  their  secreting  power;  while  alkalies  applied  in  a  corre- 
sponding way  to  glands  with  alkaline  secretions  lessen  or  check  this 
secretion. 

In  support  of  this  generalization  I  have  ventured  to  propose,  I  will 
noAv  adduce  some  practical  instances  of  the  efficient  therapeutic  employ- 
ment of  acids  or  alkalies. 

Acids  are  useful  to  allay  thirst,  by  joromoting,  through  their  topical 
action  on  the  mucous  membrane,  the  secretion  of  the  alkaline  saliva. 

Acids  given  shortly  before  a  meal  generally  check  acidity. 

Alkalies  given  shortly  before  a  meal  increase  the  secretion  of  the  acid 
gastric  juice,  and  so  promote  digestion. 

A  weak  alkaline  lotion  is  often  useful  in  the  weeping  stage  of  eczema, 
by  checking  the  alkaline  watery  exudation. 

A  weak  alkaline  injection  is  eflticacious  in  that  form  of  leucorrluea  de- 
pending on  a  too  abundant  secretion  from  the  glands  of  the  os  uteri, 
the  secretion  in  that  part  being  alkaline. 

Some  of  these  instances  will  be  referred  to  in  greater  detail  in  their 
fitting  places  in  this  volume. 


ACIDS.  123 


SULPHUEIC,   HYDKOCHLORIC,   NITEIO,   PIIOSPHOEIC, 
AND  ACETIC   ACID. 

The  members  of  this  group  are  powerful  acids,  and  accordingly  have 
a  strong  affinity  for  alkalies  and  bases.  Some,  as  sulphuric  acid  and 
phosphoric  acid,  absorb  water  with  avidity.  All  possess  high  diffusion- 
power,  and  so  pass  readily  through  animal  membranes  and  textures. 
These  are  the  properties  which  explain  most  of  their  action  on  the  liv- 
ing body. 

These  acids,  when  concentrated,  produce  decided  changes  in  the  skin 
by  tlieir  affinity  for  the  bases  and  water  of  the  tissues,  as  well  as  in  a 
minor  degree  for  the  organic  substances  themselves.  Their  great  diffu- 
sion-power enables  them  to  penetrate  readily  and  deeply  beneath  the  sur- 
face, with  a  continuous  destructive  action,  till  they  are  diluted  with  water 
or  neutralized  by  the  bases  of  the  animal  structures. 

From  their  great  affinity  for  water,  sulphuric  acid  and  phosphoric 
acid  are  especially  energetic;  they  withdraw  this  element  from  the  tex- 
tures, and  thus  effect  their  complete  destruction.  In  adequate  quantity 
they  Avill  destroy  the  tissues  to  a  considerable  depth,  and  produce  a  brown 
or  black  eschar. 

The  remaining  members  of  this  group,  owing  to  their  feeble  affinity 
for  water,  destroy  the  tissues  less  extensively,  and  their  action  is  much 
more  superficial. 

Sulphuric  acid  and  phosphoric  acid  are  never  used  undiluted,  on  ac- 
count of  their  physical  action  on  the  tissues.  On  the  other  hand,  nitric 
acid  is  frequently  employed  to  destroy  and  remove  the  surface  of  foul  and 
unhealthy  sloughs  and  ulcers,  and  in  virtue  of  a  property  of  which  we 
shall  shortly  speak,  it  changes  an  unhealthy  and  indolent  sore  into  o^.e 
more  healthy  and  prone  to  heal.  It  is  frequently  employed  in  cases  of 
soft  chancre,  indolent  and  broken  bubo,  cancrum  labialis,  etc. 

Nitric,  hydrochloric,  and  especially  acetic  acid,  may  produce  some 
vesication.     Nitric  acid  colors  the  skin  characteristically  yellow. 

No  treatment  is  easier  nor  more  speedy  or  certain  in  its  action  than 
the  application  of  strong  acetic  acid  to  ringworm  of  any  part  of  the  body 
except  the  scalp.  Nitric  acid  induces  a  healthier  action  in  indolent  ulcers, 
or  arrests  the  spreading  of  sloughing  sores. 

Acetic  acid  and  somewhat  diluted  nitric  acid,  are  frequently  applied 
to  warts,  which  are  destroyed  by  withdrawing  the  bases,  and  by  dissolving 
the  tissues  of  the  warts  themselves.  But  although  any  of  these  acids  are 
effectual,  and  in  many  cases  completely  remove  the  warty  growths,  yet 
sometimes  a  fresh  and  abundant  crop  springs  up  in  the  neighborhood 
of  those  undergoing  treatment.  Dr.  George  Bird  finds  the  glacial  acetic 
acid  very  effectual  in  removing  warty  growths.  Small  syphilitic  warts 
and  condylomata,  kept  constantly  moist  with  a  wash  of  diluted  nitric  acid 
— a  drachm  or  two  of  the  dilute  acid  to  a  pint  of  water,  is  sufficient — are 
thus  surely  aud  painlessly  dispersed. 


124  ACIDS. 

The  members  of  this  group  are  more  generally  eVnployed  externally, 
mixed  with  water.  Although  diluted,  they  still  excite  a  beneficial  irrita- 
tion, and  may  be  used  as  lotions  in  urticaria,  controlling  the  very  trouble- 
some itching,  even  preventing  the  formation  of  wheals,  and  in  some  cases 
appearing  to  be  mainly  instrumental  in  curing  this  disease. 

Acids,  especially  nitric  acid  and  hydrochloric  acid,  are  less  employed 
as  batbs  than  formerly,  yet  beyond  doubt,  they  exert  a  very  powerful  in- 
fluence on  the  skin.  A  general  bath,  with  two  to  eight  ounces  of  the 
strong  nitric  or  hydrochloric  acid,  is  a  very  active  exciter  of  a  torpid  skin. 
Whether  these  baths  have  any  elfect  on  the  other  organs  of  the  body,  is 
at  present  quite  unknown,  no  experiment  having  been  made  to  settle  this 
question.  It  is  highly  probable,  however,  that  in  common  Avith  other 
materials  dissolved  in  baths,  these  acids  remain  unabsorbed  by  the  skin, 
and  that  any  chtinge  in  the  deep  parts  of  the  body  resulting  from  medi- 
cated baths  must  be  ascribed  to  the  direct  action  of  the  dissolved  ma- 
terials on  the  skin  itself.  Spongi]ig  the  surface  of  the  body  with  water 
weakly  acidulated  with  acids  will,  in  some  cases,  effectually  control  pro- 
fuse sweating. 

They,  however,  act  as  stimulants  to  the  skin  when  stripj^ed  of  its  cuti- 
cle; thus  nitric  acid  is  frequently  used  with  much  benefit  as  a  lotion  in 
the  treatment  of  indolent  and  painful  ulcers. 

Applied  to  the  softer  tissues,  the  dermis,  mucous  membranes,  etc., 
acids  act  as  astringents,  causing  a  direct  condensation  of  the  tissues,  proba- 
bly by  removing  part  of  the  base  by  combination  with  which  the  albumi- 
nous substances  were  held  in  the  soluble  form. 

By  virtue  of  their  astringency,  they  check  profuse  secretions  from 
unhealthy  sores.  Nitric  acid  is  most  preferred  in  such  cases.  Xitric 
acid  is  generally  used  as  a  test  for  albumen,  in  solution;  it  precipitates  the 
albumen  by  abstracting  the  "base  combined  with  it,  and  in  setting  the  albu- 
men free,  converts  it  into  an  insoluble  substance. 

When  diluted,  these  acids  very  effectually  check  bleeding  from  the 
smaller  vessels  and  capillaries  by  constringing  the  tissues,  exciting  the 
muscular  coat  of  the  arteries  to  contract,  and  by  coagulating  the  blood  in 
the  ends  of  the  wounded  vessels,  and  so  plugging  them,  ^"inegar,  always 
at  hand,  will  check  bleeding  from  leech-bites,  piles,  cuts,  etc.  The  vine- 
gar should  be  diluted. 

These  acids  produce  the  same  effect  on  the  mucous  membrane  of  the 
mouth  as  on  the  skin,  and  for  the  most  part  are  used  for  the  same  pur- 
poses. Strong  nitric  acid  is  often  applied  to  foul  and  sloughing  ulcers 
of  the  mucous  membrane,  to  change  their  character  and  to  cheek  their 
progress. 

Acids  are,  in  part,  neutralized  by  the  alkaline  secretion  from  the  sal- 
ivary glands,  while  any  acid  remaining  free  precipitates  the  mucous  coat- 
ing of  the  mucous  membrane,  and  if  in  sufficient  quantity,  attacks  the 
mucous  membrane  itself.  They  act  beneficially  as  astringents,  when  the 
lining  membrane  of  the  mouth  is  relaxed  or  ulcerated,  as  in  ulcerated 
stomatitis,  salivation,  etc. ;  but  other  astringents  are  preferable.  These 
acids  being  apt  to  dissolve  the  earthy  constituents  of  the  teeth,  should  be 
taken  through  a  quill,  a  glass  tube,  or  reed. 

Nitric  acid  exerts  a  further  action  on  the  mucous  membrane  of  the 
mouth,  and  may  be  given  in  small  medicinal  doses  with  conspicuous  bene- 
fit, when  this  membrane  is  inflamed  or  diseased  in  various  ways,  as  in 
ulcerated  stomatitis,  aphthte,  salivation  from  mercury,  or  when  reddened. 


ACIDS.  125 

inflamed,  and  glazed,  a  condition  not  unfreqnently  met  with  in  great  irri- 
tatioiL  of  the  digestive  organs. 

These,  witli  other  acids,  as  citric,  tartaric,  etc.,  qnell  tlie  thirst  of  fever 
patients  mnch  more  efl'ectnally  than  sim})le  water,  esjiecially  if  the  drink 
is  made  rather  bitter  with  some  agreeable-tasting  snbstance,  as  orange- 
peel  or  cascarilla.  Mnch  of  the  tronblesome  thirst  of  fevers  is  solely  dae 
to  dryness  of  the  mouth  and  throat.  This  disagreeable  local  sensation  of 
thirst  is  very  liable  to  lead  fever  patients  to  drink  more  water  than  is 
really  good  for  them,  producing  loss  of  appetite,  indigestion,  and  even 
diarrhoi^a  and  flatulence.      (  Vide  Water. ) 

The  action  of  acids  in  lessening  thirst  has  already  been  explained  in 
the  chapters  on  the  topical  action  of  acids  and  alkalies  on  the  secretions. 
As  we  have  seen,  acids  probably  increase  alkaline  secretions,  and  tlnis 
the  acid  drinks  used  by  fever  patients  promote  an  increased  secretion  in 
the  salivary  glands.  Bitters,  as  we  shall  presently  see,  possess  the  same 
power;  hence,  acids  and  bitter  drinks  acting  on  the  salivary  glands,  keep 
the  month  and  throat  comfortably  moist  and  quench  the  thirst.  By  less- 
ening the  harassing  thirst,  they  comfort  the  patient,  qnell  irritability  of 
temper,  favor  sleep,  quiet  the  pulse,  and  diminish  the  heat  of  the  body. 
Organic  acids  are  largely  employed  as  fever  medicines. 

Acids  are  applied  to  the  throat  for  the  same  purpose  as  to  the  month. 
Undiluted  nitric  acid  acts  beneficially  as  a  topical  application  on  the  foul 
sloughs  or  nlcers  occurring  in  the  course  of  scarlet  fever  or  other  diseases. 

Bretonneau  warmly  rt^commends  the  application  of  strong  hydrochloric 
acid  to  the  throat,  in  diphtheria.  The  acid  may  be  used  undiluted,  or  it 
may  be  mixed  with  an  equal  part  of  honey,  which  gives  the  mixture  con- 
sistence, and  makes  it  cling  about  the  parts  on  which  it  is  painted.  It 
should  be  applied  only  to  those  spots  of  the  mucons  membrane  attacked 
by  the  diphtheritic  inflammation,  and  not  to  the  neighboring  healthy  tis- 
sues, where  it  would  produce  active  inflammation.  The  diphtheritic 
membrane  being  very  prone  to  implant  itself  on  inflamed  surfaces,  the 
application  of  the  acid  to  the  sound  tissues,  by  exciting  inflammation, 
might  favor  the  spread  of  the  disease. 

Lactic  acid  was  at  one  time  largely  nsed  as  a  topical  application  to 
dissolve  diphtheritic  false  membrane.  It  may  be  employed  as  spray  in 
the  strength  of  3  ss.  3  i  to  3  i,  of  water,  or  it  may  be  mopped  on  the 
diseased  parts.     It  should  be  used  every  hour  or  even  oftener. 

Nitric  acid,  in  small  medicinal  doses,  may  be  given  with  benefit, 
when  the  throat  presents  the  same  aj^pearances  as  those  of  the  month 
previously  described. 

The  albuminous  constituents  of  food  are  digested  and  rendered  solu- 
ble mainly  by  the  agency  of  acids,  but  all  acids  are  not  equally  efficient. 
Hydrochloric  acid  far  outstrips  all  others  in  this  respect,  while  sulphuric 
acid  hinders  rather  than  promotes  digestion  by  precipitating  the  albu- 
mens in  an  insoluble  form.  The  action  of  acids  on  nitrogenous  sub- 
tances  is  intensified  by  the  addition  of  pepsin. 

In  scanty  secretion  of  gastric  juice,  dilute  hydrochloric  acid  may  be 
employed  to  assist  digestion.  The  considerations  developed  in  the  section 
on  the  topical  action  of  acids  and  alkalies  on  the  secretions,  render  it  ob- 
vious, that  the  time  of  administration,  in  respect  to  meals,  is  all-important. 
If  given  before  a  meal,  acids  check  the  secretion  of  the  acid  gastric  juice, 
and  so  hinder,  instetid  of  aiding,  digestion.  Where  the  secretion  is  scanty, 
the  acid  must  be  given  after  the  meal,  when  the  secretion  from  the  mem- 


12(5  ACIDS. 

l)raneof  tlie  stomach  isromploted;  the  additional  acid  will  assist  the  action 
of  that  secreted  naturally,  but  too  scantily.  In  many  cases  of  atonic  dys- 
])epsia,  alkalies  are  preferable  to  acids,  but  they  must,  of  course,  be  given 
a  short  time  before  a  meal,  because  then  they  stimulate  an  abundant  secre- 
tion of  the  gastric  juice.  In  most  cases  of  atonic  dyspepsia,  alkalies  given 
with  the  precautions  noted,  are  superior  to  acids  given  after  a  meal, 
although,  as  is  well  known,  certain  cases  occur  where  acids  answer  better 
than  alkalies.  In  such  cases,  the  mucous  membrane  is  presumably  consid- 
erably damaged  by  excesses  in  eating  or  drinking,  and  owing  to  degenera- 
tion of  the  glands  of  the  stomach,  no  stimulant  could  excite  a  sufllicient 
flow  of  gastric  juice. 

Acids,  as  we  have  seen,  Avill  check  or  lessen  the  secretion  of  gastric 
juice.  In  many  stomach  diseases,  or  from  its  sympathy  with  distant 
organs,  the  follicles  pour  into  the  stomach  an  excess  of  acid,  which  undue 
secretion  may  be  checked  by  the  administration  of  acids  shortly  before 
food.  But  acidity  of  the  stomach  is  often  due  to  excessive  or  irregular 
fermentation,  leading  to  the  production  of  a  large  quantity  of  various 
acids,  as  acetic,  butyric,  mid  lactic;  and  this  excessive  or  irregular  fer- 
mentation of  acids  is  itself  checked  by  acids;  and  as  undue  secretion  of 
the  gastric  juice,  or  excessive  formation  of  acids  by  fermentation,  are  the 
two  causes  of  acidity,  Ave  have  in  acids  themselves,  remedies  able  to  con- 
trol and  check  the  acidity  of  the  stomach,  and  relieve  the  consequent  dis- 
tressing symptoms,  whether  due  to  pregnancy,'  uterine  disease,  calculus 
of  the  kidneys,  the  various  indigestions,  or  more  serious  diseases  of  the 
stomach. 

Practical  men,  indeed,  know  well  that  the  administration  of  an  acid, 
will  remove  acid  eructations,  heartburn,  and  the  sense  of  discomfort  at  the 
chest  and  epigastrium,  arising  from  excess  of  acid  in  the  stomach. 
Hydrochloric,  lactic,  or  nitric  acid,  is  generally  preferred,  and  small  me- 
dicinal doses,  separately  or  combined,  are  ordinarily  sufficient,  provided 
the  prescribed  conditions  are  obeyed. 

Patients  are  sometimes  greatly  annoyed  by  eructations  of  an  oft'ensive 
gas,  with  the  odor  and  flavoi  of  rotten  eggs — a  gas  evidently  consisting 
largely  of  sulphuretted  hydrogen.  The  late  Dr.  Day,  of  St.  Andrew's, 
noticed  that  in  such  cases  the  urine  is  loaded  with  oxalic  acid,  and  in  their 
treatment,  he  strongly  recommended  the  employment  of  mineral  acids. 
Dyspeptics  with  oxalic  acid  in  the  urine,  who  sutfer  from  great  mental 
depression,  but  who  are  free  from  sulphuretted  hydrogen  eructations,  find 
much  benefit  from  nitric  acid  treatment. 

In  the  treatment  of  dyspepsias,  a  clue  to  the  administration  of  acids  on 
the  one  hand,  or  of  alkalies  on  the  other,  may  sometimes  be  obtained  by 
testing  the  reaction  of  the  fluids  ejected  from  the  stomach.  Not  unfre- 
(piently,  soon  after  a  meal,  fluid  regurgitates  almost  unconsciously  into 
the  mouth,  sometimes  so  strongly  acid  that  it  sets  the  patient's  teeth. on 
edge.  The  exhibition  of  nitric  or  hydrochloric  acid  shortly  before  each 
meal,  almost  immediately  removes  this  acid  pyrosis.  Sometimes  the  fluid 
of  pyrosis  has  an  alkaline  reaction,  often  accompanied  with  much  distress, 
with  nausea,  and  vomiting  of  the  just-eaten  food,  and  the  rejected  con- 
tents of  the  stomach  generally  show  a  strong  alkaline  reaction.  Here 
an  acid  immediately  after  a  meal  relieves  the  nausea,  the  vomiting,  and 

'  Two  or  three  drops  of  tincture  of  nux  vomica,  taken  a  few  minutes  before  meals 
will  ol'teu  obviate  the  acidity  of  pregnancy.     Sometimes  ipecacuanlia  will  control  it. 


ACIDS.  127 

all  distressing  symptoms.  On  theoretical  grounds,  we  should  expect  that 
an  alkali,  administered  shortly  before  food,  would  yield  even  more  satis- 
factory results,  hut  in  such  cases  I  have  had  no  experience  of  alkalies. 

It  need  hardly  be  repeated  that  acids  given  soon  after  a  meal  to  patients 
troubled  with  acidity  and  heartburn,  greatly  aggravate  the  suifering.  It 
is  adding  fuel  to  the  tire.  If  continued  too  long  these  remedies  may 
not  only  check  undue  acidity  of  the  stomach,  but  even  exceed  this  office, 
and  by  lessening  the  secretion  of  gastric  juice  to  an  undue  extent,  actually 
induce  the  very  opposite  condition  to  that  for  which,  in  the  first  instance, 
they  were  employed.  Those  who  have  watched  the  action  of  acids  on 
the  stomach,  well  know  that  if  too  long  continued,  the  improvement  first 
noticed  ceases  by  degrees,  then  fresh  symptoms  arise,  which,  strangely 
enough,  are  relieved  by  the  very  opposite  treatment  which  had  previously 
benefited. 

Too  long  a  course  of  acids  excites  catarrhal  inflammation  of  the  mucous 
coat  of  the  stomach  and  intestines,  often  accompanied  by  diarrhoea,  and 
even  by  genoral  wasting.  This  damaging  action  of  acids  explains  the 
occasional  thinning  effects  of  vinegar,  when  taken  for  a  long  time,  by  fat 
people.  Vinegar  is  sometimes  taken  surreptitiously  in  wineglassf  uls  several 
times  a  day  to  reduce  obesity.  This  foolish  practice,  which  cannot  be  too 
strongly  condemned,  may  thin  the  patient,  but  it  does  so  at  the  expense 
of  serious  injury  to  the  body.     Obesity  can  be  reduced  by  harmless  means. 

These  acids  are  inoperative  to  check  the  growth  of  sarcinge  in  the 
stomach;  and  they  often  fail  even  to  check  the  acidity  accompanying  these 
growths. 

It  is  a  common  practice  with  drunken  soldiers  to  drink  a  wineglassful 
of  vinegar  in  a  tumbler  of  Avater,  to  cut  short  intoxication;  but  whether 
it  does  sober  a  drunkard  is  not  certain,  but  it  seems  to  steady  a  tipsy 
soldier  and  to  enable  him  to  pass  muster  on  presenting  himself  at  barracks. 

By  virtue  of  their  astringent  action,  and  their  power  of  coagulating  the 
lilood,  acids  are  useful  in  bleeding  from  the  stomach.  Sulphuric  acid  is 
generally  preferred  to  the  other  members  of  this  group.  But  many  other 
astringents  are  surer. 

Owing  to  their  high  diffusion-power,  these  acids  pass  readily  from  the 
stomach  into  the  blood.  The  acids  which  pass  into  the  intestines  must, 
to  a  great  extent,  become  neutralized  by  the  alkalies  of  the  bile  and  pan- 
creatic juice,  and  therefore,  as  acids,  can,  by  direct  contact,  affect  to  a 
very  small  extent  the  middle  and  lower  part  of  the  intestinal  tract.  But 
as  they  become  neutralized,  some  of  the  biliary  and  weaker  acids  are  set 
free,  heightening  in  some  degree  the  acidity  of  the  contents  of  the  intes- 
tines. 

Dilute  acids  are  used  as  antidotes  in  poisoning  by  alkalies.  It  has  been 
shown  experimentally  that  acids  applied  to  the  mucous  membrane  of  the 
duodenum  cause  an  increased  flow  of  bile,  attributed  to  the  consequent 
contraction  of  the  gall  bladder  and  bile  ducts.  I  suggest  that  part  at  least 
of  this  augmented  flow  is  due  to  increased  secretion  brought  about  in  ac- 
cordance with  the  alkali  acid  (V.  Section  7)  theory  I  have  propounded, 
the  acid  contents  of  the  duodenum  stimulating  the  secretion  of  the  alka- 
line bile,  and  the  still  more  alkaline  pancreatic  juice. 

It  has  long  been  held  that*  nitric  acid  acts  in  some  way  beneficially  on 
long-standing  diseases  of  the  liver,  as  in  chronic  congestion  and  ciri'hosis, 
and  that  it  will  augment  the  flow  of  bile  after  the  liver  has  struck  work 
from  the  excessive  use  of  mercury. 


128  Acros. 

From  his  experiments  on  fasting  dogs,  Rutherford  conchides  that 
nitro-h3'droehloric  acid  is  an  hepatic  stimulant,  thus  confirming  the  con- 
clusions founded  on  clinical  experience. 

There  can  be  no  doubt  that  sulpliuric  acid  is  highly  useful  in  checking 
summer  and  choleraic  diarrhcea,  although,  as  it  is  generally  administered 
with  opium  and  warm  carminatives,  it  is  difficult  to  distribute  to  each 
remedy  its  exact  share  of  merit.  Its  mode  of  action  is  less  obvious  than 
its  efficacy.  It  may  control  the  formation  of  acid  in  the  intestines,  or  it 
may  act  as  an  astringent,  and  so  check  diarrhoea.  If,  then,  it  acts  as  an 
astringent,  as  the  acid  is  soon  neutralized  and  converted  into  a  sulphate 
in  the  upper  part  of  the  small  intestines,  losing  its  astringency  at  once, 
its  influence  on  the  lower  and  middle  part  of  the  small  intestine  must  be 
exerted  through  nervous  sympathy  between  one  part  of  this  canal  and 
another.  Sulphuric  acid  is  considered  to  act  often  capriciously,  giving 
rise  to  much  uncertainty  in  its  administration;  but  the  lack  of  uniform- 
ity in  its  results  can  be  accounted  for,  in  many  instances,  by  the  dose;  a 
small  medicinal  dose  often  benefits,  whilst  a  full  one,  by  increasing  the 
acidity  of  the  canal,  may  even  aggravate  the  diarrhoea.  Dr.  Neligan,  and 
other  authorities,  recommend  it  in  chronic  diarrhoea,  and  to  control  the 
"  profuse  sweating  and  colliquative  diarrhoea  of  hectic." 

In  small  medicinal  doses,  nitric  acid  is  of  great  use  in  many  diar- 
rhoeas; it  often  acts  admirably  in  the  straining  diarrhoea  of  children; 
when  the  motions  are  green,  curdled,  and  mixed  with  mucus,  other  rem- 
edies are  to  be  preferred  to  acids.  Nitric  acid  may  sometimes  be  used 
with  great  benefit,  especially  when  given  with  pepsin,  in  that  chronic 
diarrhrea  of  children  when  the  jjale  and  pasty  motions  smell  sour  and 
disagreeable. 

Strong  nitric  acid  is  an  efficient  remedy  for  internal  piles,  two  or  at 
most  three  ap2:)lications  to  the  enlarged  and  dilated  vessel  being  suffi- 
cient; it  should  not  be  applied  to  the  whole  surface,  but  only  to  one  or 
two  points.  It  is  useful,  too,  in  granular  or  ulcerated  piles.  It  i^roduces 
little  or  no  pain.  A  superficial  slough  follows,  and  after  the  separation 
of  the  slough  the  contraction  of  the  sore  diminishes  the  size  of  the  pile. 
A  drachm  or  half  a  drachm  of  the  dilute  nitric  acid  to  half  a  pint  of 
water,  is  an  excellent  lotion  for  bleeding  piles,  staying  the  haemorrhage, 
constringing  the  swollen  and  inflamed  tumor,  and  easing  the  heavy,  ten- 
sive, Avearying  pain.  Acids  are  reputed  to  heighten  the  action  of  pur- 
gative medicines,  and  for  this  purpose  sulphuric  acid  is  sometimes  em- 
ployed. Sulphuric  acid  increases  the  purgative  effect  of  extract  of  aloes. 
Acids  are  usually  added  to  purgative  salts,  as  Epsom  salt,  when  a  tonic 
and  bracing  action  on  the  mucous  membrane  is  desired,  as  in  many  cases 
of  anemia  of  young  Avomen. 

If  not  already  neutralized  on  their  passage  into  the  blood,  these  acids 
must  at  once  become  so,  and  it  would  appear  that  henceforth  their  history 
must  follow  that  of  the  salts  they  form.  Yet  the  received  notion  of  the 
action  of  these  acids  on  the  organs  of  the  body  is  so  different  from  that  of 
any  of  their  salts,  that  the  behavior  of  the  acids  must  be  spoken  of  sepa- 
rately. 

On  combining  with  the  alkalies  of  the  blood,  the  acids  must  set  free 
some  weaker  acids,  and  so  to  a  slight  extent  lessen  the  alkalinity  of  that 
fluid,  as  is  evidenced  by  the  increased  acid  reaction  of  the  urine  folloAving 
the  use  of  mineral  acids.    What  further  eifects  tliev  mav  have  on  the  blood 


ACIDS.  129 

is  at  present  quite  unknown.  They  are  reputed  to  be  tonic  and  bracing, 
but  the  improvement  in  the  general  health  may  more  safely  be  attributed 
to  their  action  on  the  intestinal  canal.  Still,  they  do  produce  certain 
changes  in  the  fluids  and  solids  of  the  body,  since  in  the  absence  of  lime- 
juice  or  fresh  vegetables,  acids,  especially  vinegar,  act  as  preventives  of 
scurvy. 

The  functions  of  the  body  are  supported  only  with  alkaline  or  neutral 
blood.  Slight  acidity  is  at  once  desti'uctive  of  all  function.  This  is  well 
seen  in  experiments  with  the  detached  frog's  heart.  When  supplied  with 
blood,  or  with  saline  solution  and  a  physiological  quantity  of  potash  and 
lime  salts,  if  a  small  quantity  of  acid  is  added,  enough  to  cause  the  faintest 
reaction,  the  heart  soon  ceases  to  beat  spontaneously,  and  in  a  little  while 
all  contractility  is  lost,  the  ventricle  refusing  to  contract  when  stimulated 
by  a  strong  faradaic  shock.  I  find  that  a  ventricle  will  beat  for  hours 
when  fed  by  a  neutral  solution,  composed  of  saline  solution  containing 
one  ten-thousandth  part  of  potassium  chloride  and  a  minute  dose  of  cal- 
cium chloride.  It  is  obvious  then  that  alkali  in  the  blood  is  not  necessary 
for  function.  But  with  every  performance  of  function  acid  is  formed, 
certainly  in  the  muscles,  and  soon  the  neutral  fluid  would  become  acid, 
when  function  would  be  destroyed.  The  alkali  of  the  blood  neutralizes 
the  acid  and  prevents  its  depressing  effect  on  the  tissues. 

Hydrochloric  acid  is  frequently  given  in  fevers,  especially  of  a  typhoid 
character,  and  phosphoric  acid  in  cases  of  nervous  weakness. 

Dr.  Eees  recommends  large  doses  of  lime-juice  to  the  extent  of  eight 
ounces  daily,  in  acute  rheumatism.  Dr.  Inman  speaks  highly  of  this 
treatment,  and  observes  that  neither  tartaric  nor  citric  acids  nor  lemon- 
juice  can  be  substituted  for  lime-juice. 

Nitric  acid  is  recommended  in  secondary  syphilis.  It  has  been  said 
sometimes  to  induce  salivation;  if  so,  this  may  have  been  due  to  the  direct 
action  of  the  acid  on  the  mucous  membrane  by  increasing  the  alkaline 
secretion  of  the  salivary  glands. 

Acids  seem  sometimes  to  abate  the  rapidity  of  the  pulse  in  fevers,  a 
result  not  due  probably  to  the  direct  action  of  the  acid  on  the  heart  or 
nervous  centres,  but  more  likely  to  the  relief  arising  from  diminished  thirst. 
Sulphuric  acid,  especially  in  conjunction  with  sulphate  of  zinc  checks  the 
profuse  sweating  of  phthisis  and  other  exhausting  diseases.  Dr.  Graves 
ascribed  a  similar  action  to  vinegar,  and  often  used  this  favorite  receipt: 
Distilled  vinegar  3  ij,  Laurel  water  3  ij,  Syrup  3  vj.  Aqua  3  v.  An 
ounce  or  two  ounces  to  be  taken  every  third  or  fourth  hour.  Sulphuric 
acid  is  supposed  to  check  bleeding  from  the  lungs  or  womb.  It  is  diffi- 
cult, indeed,  to  understand  how  an  ordinary  dose  of  sulphuric  acid  can 
exercise  such  an  influence  after  becoming  so  greatly  diluted  by  admixture 
with  the  blood,  and  the  difficulty  is  enhanced  by  the  consideration  that 
these  acids,  either  before  or  immediately  after  their  entrance  into  the  cir- 
culation, are  converted  into  salts,  as  sidphates,  nitrates,  and  phosphates. 
Whatever  influence,  therefore,  is  exerted  on  distant  organs  must  be  effect- 
ed through  these  combinations;  yet  we  cannot  ascribe  to  any  salts  of  these 
acids  properties  similar  to  those  ascribed  to  the  acids  themselves. 

In  such  questions  experience  is  a  safer  guide  than  speculation.  The 
subtle  influence  of  even  small  doses  on  distant  organs  of  the  body  is  well 
exemplified  by  the  effect  of  these  medicines  on  the  mother's  milk;  for 
acids  taken  for  some  time  induce  in  the  child  sickness,  diarrhoea,  and 
colicky  pains. 

9 


130  SULPHUROUS    ACID. 

Many  recommend  acids  in  chronic  bronchitis,  and  find  that  they  les- 
sen secretion.  Ivohrig,  in  his  experiments  on  animals,  found  that  acids 
lessened  the  secretion  from  the  tracheal  mucous  membrane. 

Phosphoric  and  lactic  acids  are  employed  in  diabetes.  Griesinger,  who 
has  carefully  studied  the  action  of  phosphoric  acid,  considers  that  it  does 
more  harm  ithan  good.  He  employed  the  acid  to  the  extent  of  an  ounce 
daily,  and  found  that  this  dose  increased  the  sugar.  Since  the  members 
of  this  group  augment  the  acidity  of  the  urine,  it  has  been  proposed  to 
dissolve  phosphatic  calculi  by  artificially  acidifying  the  urine,  but  since 
these  acids  but  slightly  augment  the  acidity  of  urine  they  must  be  taken 
for  a  prolonged  period  before  they  could  materially  diminish  the  bulk  of 
a  stone;  moreover  there  remains  the  insuperable  objection  that  this 
method  of  treating  calculi  would  seriously  damage  the  mucous  membrane 
of  the  stomach  and  intestines. 

Sucking  the  juice  of  one  or  two  lemons  is  a  domestic  remedy  for 
excessive  menstrual  fiow. 

The  injection  of  nitric  acid,  sufficiently  diluted,  has  been  employed 
with  success  by  some  eminent  surgeons,  and  is  a  far  more  effectual  treat- 
ment for  phosphatic  calculi.  The  experiments  of  Sir  W.  Roberts,  on  the 
solvent  power  of  dilute  solutions  of  this  acid  on  calculi,  after  their  re- 
moval from  the  body,  lead  him  to  the  conviction  that  this  treatment  is 
worthy  of  much  wider  apjDlication  than  it  at  present  receives;  moreover, 
by  neutralizing  the  urine  if  alkaline,  and  preventing  its  decomposition, 
nitric  acid  injections  protect  the  mucous  membrane  of  the  bladder  f j'om 
the  irritation  of  the  alkaline  urine. 

The  further  infinence  of  sulphuric,  nitric,  and  hydrochloric  acids  on 
the  urine  is  unknown.  Of  the  influence  of  acetic  and  phosphoric  acids 
we  shall  speak  in  another  place. 

It  should  be  remembered  that  phosphoric  acid  may  possess  many  other 
properties  than  those  already  specified,  but  these  will  be  referred  to  in 
speaking  of  the  phosphates,  i'or  it  is  in  this  form  that  phosphoric  acid 
exists  in  the  blood,  and  manifests  many  of  its  beneficial  effects  on  the 
diseased  body. 


SULPHUROUS  ACID,    SULPHITES,    HYPOSULPHITES. 

SuLPnuROUS  acid  is  generally  considered  a  potent  poison  to  the  lower 
forms  of  life,  and  is  commonly  used  as  a  deodorizer  and  disinfectant.  It 
is  a  deodorizer  by  virtue  of  its  power  to  arrest  putrefaction ;  hence  it  may 
be  used  to  prevent  bad  smells,  but  it  possesses  little  or  no  power  to  decom- 
pose ofliensive  gases,  and  therefore  it  is  of  little  service  in  destroying  foul 
odors.  It  arrests  fermentation  by  destroying  the  minute  organisms  which 
determine  this  process.  It  is  supposed  to  disinfect  by  destroying  the 
micro-organisms  that  propagate  contagious  diseases.  Roch's  experiments, 
however,  satisfy  him  that  sulphurous"  acid,  gaseous  or  in  watery  solution, 
is  not  a  disinfectant  and  does  not  destroy  bacterial  life. 

It  must  be  borne  in  mind  that  sulphurous  acid  corrodes  metals,  so 
that,  when  used  as  a  disinfectant,  these  sbould  be  protected  by  a  covering 
of  some  greasy  substance.  In  fumigating  a  room,  sufficient  sulphur, 
about  an  ounce  to  each  hundred  cubic  feet  of  space,  should  be  burned  to 


SULPHUROUS    ACID.  131 

render  the  air  unfit  for  respiration,  and  the  escape  of  the  gas  by  the  chim- 
ney, windows,  and  crevices  of  the  doors,  should  be  prevented.  It  is  better 
to  repeat  this  process  three  or  fonr  times  at  intervals  of  twenty-four  hours. 
To  disinfect  a  bed,  ]\Ir.  Startin  recommends  that  a  warming-pan  corjtain- 
ing  live  coals  sprinkled  with  sulphur  should  be  put  between  the  clothes, 
till  the  sulphur  is  consumed.  A  damp  napkin  held  before  the  mouth 
will  prevent  sulphurous  acid  from  irritating  the  lungs.  It  is  far  better, 
however,  to  submit  the  bedding,  etc.,  which  cannot  be  boiled,  for  some 
hours  to  a  temperature  between  250  °  and  300°  in  a  disinfecting  chamber 
or  oven. 

Baxter  finds  that  sulphurous  acid  is  more  destructive  of  the  vaccine 
virus  than  either  chlorine  or  carbolic  acid. 

The  quickest  way  of  curing  itch  is  to  immerse  the  patient,  leaving 
his  head  free,  in  a  gaseous  bath  of  sulphurous  acid,  made  by  burning  12 
drachms  of  sulphur  in  a  suitable  apparatus.  AVhilst  in  the  bath,  the 
patient's  clothes  should  be  baked,  so  that  in  half  an  hour  he  is  cured  of 
his  itch,  and  is  made  free  from  risk  of  re- infection. 

The  acid  will  cure  chloasma,  by  destroying  the  parasite  on  wdiicli  the 
disease  depends.  The  acid  of  the  Pharmacopoeia,  mixed  with  an  equal 
quantity  of  glycerine,  may  be  used.  Warm  baths  should  also  be  employed 
to  remove  the  cuticle  infested  by  the  parasite.  It  is  useful  also  in  favus, 
and  in  tinea  tonsurans;  but  when  these  aifections  are  unusually  obstinate, 
its  action  should  bo  assisted  by  epilation. 

Dr.  Dewar,  of  Kirkaldy,  has  drawn  attention  to  the  beneficial  action  of 
sulphurous  acid  in  various  diseases,  and  many  of  his  statements  have  been 
confirmed  by  subsequent  observers. 

Dr.  Dewar  applies  the  sulphurous  acid  in  three  ways, — as  a  solution, 
by  fumigation,  and  by  the  spray-producer.  A  solution  of  the  acid  or 
fumigation  with  it,  he  says,  will  speedily  cure  chilblains  and  chapped 
hands.  Equal  parts  of  the  acid  of  the  Pharmacopoeia,  and  of  water  or 
glycerine  Avill,  he  states,  at  once  ease  the  burning,  and  prevent  the  spread 
of  erysipelas.  Wounds  and  sore  nipples  he  treats  with  the  solution,  con- 
stantly applied,  either  neat  or  diluted.  The  same  treatment,  he  says,  Avill 
preveiit  or  quickly  dissipate  the  eifects  of  bruises. 

According  to  the  same  authority,  many  internal  diseases  are  equally 
amenable  to  sulphurous  acid;  amongst  others,  cold  in  the  head,  influenza, 
tonsillitis,  malignant  sore-throat  (scarlatinal  or  otherwise),  laryngitis, 
chronic  bronchitis,  chronic  phthisis,  asthma,  croup,  clergyman's  hoarse- 
ness, and  tyhoid  fever. 

The  acid  may  be  applied  to  the  throat  by  fumigation,  or  by  inhala- 
tion: a  few  drops  should  be  added  to  boiling  water,  and  the  steam  inhaled; 
or  the  acid  may  be  applied  by  a  camel-hair  brush,  or  by  the  spray-producer. 

It  may  be  carried  into  the  lungs  by  fumigation,  inhalation,  or  by  spray. 
If  properly  and  carefnlly  employed,  the  Pharmacopoeia  acid  excites 
scarcely  any  irritation  or  annoyance.  The  application  of  sulphurous  acid 
may  be  conducted  in  the  following  ways: — 

"  Put  a  few  red  cinders  into  a  kitchen  shovel,  set  this  upon  a  wooden 
stool,  and  then  sprinkle  flowers  of  sulphur  from  time  to  time  till  the 
room  is  not  inconveniently  filled  with  smoke. " 

The  spray  may  be  applied  by  a  vaporizer  now  in  common  use,  fur- 
nished with  vulcanite  tubes  constructed  upon  Dr.  Dewar's  plan.  For  a 
child  the  instrument  should  be  held  about  three  feet  from  the  mouth,  and 
the  fine  spray  should  be  inhaled  and  the  process  repeated  according  to 


132  CHROMIC    ACID. 

circumstances.  In  an  acute  attack  of  diphtheria  with  no  time  to  lose, 
it  may  be  repeated  liourly,  or  even  oftener.  Sulphurous  acid  may  also  be 
used  as  a  gargle  or  wash. 

In  applying  the  spray  to  adults,  Dr.  De war  directs  the  operator  "to 
hold  the  nozzle  of  the  instrument  about  six  inches  from  the  patient's 
month,  and  administer  three  or  four  wliiifs  to  begin  Avith;  then,  after  a 
corresponding  interval,  during  which  a  cough  or  two  is  given,  the  process 
is  repeated,  about  twenty  squeezes,  in  all,  which  represents  the  injection 
of  from  forty  to  sixty  minims  of  acid.     The  acid  should  be  pure." 

For  the  relief  of  rheumatism  and  gout,  besides  the  fumigation.  Dr. 
Dewar  advises  that  the  bed-clothes  should  be  exposed  to  the  strong  fumes, 
and  then  spread  over  the  patient,  who  after  sweating  and  sleeping  wakes 
much  relieved. 

The  solution,  either  strong  or  diluted  in  various  proportions,  speedily 
removes  thrush.  Dr.  Lawson  speaks  highly  of  sulphurous  acid  as  a 
remedy  for  pyrosis;  indee  \  he  says  it  never  fails  to  be  of  service,  and  in 
my  experience  it  seldom  fails.  Ten  to  fifteen  minims  should  be  taken  ten 
minutes  before  &ach  meal.     The  sulphite  he  finds  useless. 

Sulphurous  acid  in  doses  of  five  to  ten  minims  often  prevents  flatulence 
produced  by  fermentation,  and  is  especially  useful  when  the  gas  is  abun- 
dant. It  is  more  efficient  than  sulphites  and  hyposulphites.  Sulphurous 
acid  is  useful  as  a  wash  or  gargle  in  diphtheria. 

Sulphites,  administered  by  the  mouth,  will,  it  is  said,  prevent  decom- 
position and  putrefaction  of  urine  in  the  bladder. 

Sulphites  and  hyposulphites  have  been  employed  to  destroy  sarcmi» 
and  torulte  in  the  stomach. 

It  is  said  that  hyposulphite  of  soda,  in  fifteen  to  twenty  grain  doses 
every  two  hours,  will  cure  intermittent  fever,  but  more  careful  observers 
do  not  corroborate  this  statement. 

It  was  at  one  time  said  to  be  useful  in  the  acute  specific  fevers. 


CHEOMIC   ACID. 


Chromic  acid  coagulates  albumen,  powerfully  oxidizes  organic  mat- 
ter, destroys  low  organisms,  and  decomposes  ammonia  and  sulphuretted 
hydrogen,  and  so  acts  as  a  disinfectant  and  deodorizer. 

Chromic  acid  was  first  used  as  an  escharotic  by  Mr.  John  Marshall, 
who  employed  it  to  remove  warty  growths  from  the  nose,  genital  orgaus, 
or  elsewhere.  Immediately  after  touching  the  parts  with  chromic  acid 
Mr.  Marshall  applies  lead  lotion, "  Mdiicli  restrains  the  subsequent  inflam- 
mation, relieves  the  subsequent  soreness,  and  does  not  in  any  way  neu- 
tralize or  retard  the  rapid  effects  of  this  apparently  useful  escharotic." 
He  uses  a  solution  containing  a  hundred  grains  of  crystallized  chromic 
acid  to  an  ounce  of  water.  "  The  solution  is  best  applied  by  the  aid  of  a 
pointed  glass  rod,  or  when  a  large  quantity  is  needed,  by  means  of  a 
small  glass  tube,  drawn  to  a  point,  (inly  so  much  should  be  applied  as 
will  saturate  the  diseased  growth,  avoiding  the  surrounding  healtliy 
mucous  membrane,  for,  though  the  solution  is  not  sufficiently  powerful 
as  an  escharotic  to  destroy  or  even  vesicate  the  mucous  mem])rane.  it 
may  give  rise  to  an  unnecessary  amount  of  inflammation."  "Any 
superfluous  acid  may  be  removed  by  a  piece  of  wet  lint.  The  first  effect 
of  its  application  to  the  warts  is  to  ])roduce  a  flight  smarting  pain.  If, 
however,  any  ulcerated  surface  be  touched,  the  pain  is  of  a  buruiug 


ALKALIES.  133 

character,  more  lasting,  but  not  so  acute  and  intolerable  as  that  caused  by 
nitrate  of  silver,  or  by  nitric  acid,  with  or  without  arsenious  acid.  Under 
its  influence,  the  morbid  growths  rapidly  waste,  in  some  cases  being 
thrown  off  altogether,  and  in  others  undergoing  a  partial,  though  evident, 
diminution  in  size.  The  best  immediate  dressing  is  dry  lint,  afterwards 
the  part  may  be  Avashed  with  lead  lotion,  and  dressed  with  lint  moistened 
in  the  same."  "  In  most  cases  one  application  suffices,  the  cure  being 
completed  in  from  four  to  eight  days.  In  severe  cases,  where  the  warts 
are  large,  repeated  applications  are  necessary."  Mr.  Marshall  further 
states  that  "chromic  acid  solution  neither  burns  nor  stains  linen;  it  all 
washes  out." 


BORIC   OR  BORACIC  ACID. 

This  substance  is  largely  used  as  an  antiseptic  dressing  for  wounds, 
and  is  employed  as  a  lotion  or  ointment.  The  lotion  is  composed  of 
one  part  of  boracic  acid  in  twenty  of  hot  water.  It  is  not,  however,  de- 
structive to  all  low  organic  growths.  The  ointment  is  now  largely  used 
for  burns,  eczema,  etc.  The  lotion  is  often  useful  in  pruritus  pudendi, 
eczema  of  the  vulva,  some  forms  of  leucorrhoea,  and  vaginitis.  Ayon  finds 
that  it  has  very  little  physiological  action.  A  pint  of  saturated  solution 
of  boracic  acid  used  daily  to  flush  the  nose  is  very  useful  in  chronic  ozoena. 
The  saturated  solution  is  also  useful  to  wash  out  abscesses,  emjiysmas, 
etc.  It  is  less  irritating  than  many  substances  used  for  the  purpose. 
Mixed  with  starch  it  is  highly  sjioken  of  as  a  dusting  powder  for  infants. 

The  late  Dr.  Simpson,  of  Highgate,  told  me  that  boracic  acid  dissolved 
in  glycerine  is  a  very  useful  local  application  in  diphtheria.  In  a  letter 
to  me,  he  says: — "During  the  last  epidemic  of  diphtheria  I  have  used 
boracic  acid  dissolved  in  glycerine  (in  a  water  bath)  of  the  strength  of  1 
in  30,  applied  by  means  of  a  brush  to  the  throat,  every  two  hours  day 
and  night,  until  all  traces  of  membrane  had  disappeared.  The  patches 
took  on  a  white  color,  with  no  offensive  odor  emanating,  and  in  the 
course  probably  of  forty-eight  hours,  and  often  much  earlier,  no  trace 
of  membrane  was  visible.  Dr.  Cossar  Ewart  and  I  found  by  experiment 
that  bacteria  present  in  the  membrane  so  treated  could  not  be  propa- 
gated. Children  do  not  dislike  the  taste.  I  find  boracic  acid,  of 
strength  of  1  in  50,  of  service  also,  in  stomatitis." 

An  ointment  composed  of  three  parts  of  acid,  five  of  paraffin  and 
ten  of  vaseline,  makes  a  good  ointment  for  eczema  and  burns. 

Boracic  acid  in  solution  or  mixed  with  honey  or  glycerine  (1  in  4  or 
5)  is  useful  in  simple  and  ulcerative  stomatitis  and  in  thrush. 

Boro-glyceride,  discovered  by  Barft',  is  powerfully  antiseptic,  and  is 
recommended  to  preserve  meat  and  vegetables.  Barff  shows  that  it  will 
preserve  meat  for  months  without  impairing  its  quality.  It  is  useful  as 
an  injection  in  ozoena,  vaginitis,  and  urethritis. 


Group  embracing  CAUSTIC  POTASH,  SOLUTION  OF  POTASH, 
CARBONATE  AND  BICARBONATE  OF  POTASH,  ACETATE 
OF  POTASH,  CITRATE  OF  POTASH,  and  the  corresponding 
preparations  of  SODA,  POTASH   SOAP,  SODA  SOAP,  BORAX. 

The  members  of  this  group  are  all  endowed  with  very  high  diffusion- 
power,  the  potash  in  a  greater  degree  than  the  soda-safts.     All  are  very 


184  ALKALIES. 

freely  soluble  in  water.  With  the  exception  of  the  acetates  and  citrates 
of  potash  or  soda,,  they  have  an  alkaline  reaction,  weak  in  some,  as  the 
hiborato  of  soda,  but  very  marked  in  others,  as  caustic  potash  or  soda. 

They  dissolve  the  nitrogenous  constituents  of  the  animal  textures,  and 
their  solvent  power  is  in  proportion  to,  yet  distinct  from,  their  affinity 
for  Avater. 

Owing  to  their  affinity  for  water,  and  their  solvent  action  on  the  nitrog- 
enous tissues,  several  of  these  substances,  by  abstracting  the  constituent 
water,  will  destroy  the  skin  or  other  structures  to  a  considerable  depth. 
The  caustic  alkalies  possess  a  greater  affinity  for  water,  and  therefore  a 
more  solvent  and  destructive  action  on  the  tissues  than  the  remaining 
members  of  this  group.  The  carbonates  and  solutions  of  the  caustic  al- 
kalies come  next;  while  the  bicarbonates,  acetates,  and  the  rest  of  this 
group,  are  comparatively  feeble  agents. 

The  caustic  alkalies,  undiluted,  or  sometimes  mixed  with  caustic  lime 
to  lessen  their  activity,  are  occasionally  employed  to  destroy  warty 
growths  or  the  hard  edges  of  some  unhealing  sores,  such  as  chancres,  or 
to  open  abscesses,  or  to  make  issues. 

It  must  be  borne  in  mind  that,  in  common  with  the  rest  of  this  group, 
the  caustic  alkalies,  possessing  a  very  bigli  dilfusion-power,  will  penetrate 
the  tissues  and  destroy  them  widely  and  deeply;  unless  great  care  is  taken, 
the  undue  diffusion  of  the  alkali  will  destroy  a  far  larger  amount  of  struc- 
ture than  is  intended,  producing  a  large  slough,  and  leaving,  of  course, 
a  correspondingly  large  sore.  The  application  of  the  alkali  should  always 
be  checked  before  it  has  taken  full  effect,  since  the  destructive  effect  Avill 
continue  for  some  hours;  other  precautions  should  likewise  be  observed, 
or  the  caustic  alkali  dissolved  in  the  fluids  of  the  tissues  will  run  over  a 
large  surface,  subsequently  destroying  it.  In  making  an  issue,  pieces  of 
plaster,  with  a  hob  in  them  of  the  required  size,  should  be  ^^laced  one 
over  the  other,  and  the  caustic  applied  to  the  skin  exposed  through  the 
hole,  while  the  neighboring  parts  are  effectually  protected.  As  soon  as 
the  application  is  finished,  it  is  desirable  to  wash  the  surface  with  vinegar 
and  water,  to  neutralize  any  remaining  alkali.  The  caustic,  very  slighth^ 
moistened,  should  be  rubbed  on  the  surface  till  it  assumes  a  dull  bluish 
look,  and  till  the  cuticle  is  softened  and  easily  rubs  off,  when  the  applica- 
tion of  a  poultice  will  help  the  separation  of  the  dead  parts,  and  ease  the 
pain. 

A  solution  of  a  member  of  this  group  sponged  over  the  peccant  part 
will  often  allay  the  troublesome  itching  accompanying  many  skin  dis- 
eases. A  Aveak  solution  of  the  caustic  salt,  or  of  its  carbonate  is  best. 
A  solution  of  carbonate  of  potash  or  soda,  containing  a  drachm  of  the  salt 
to  a  pint  of  water,  applied  with  a  small  piece  of  sponge,  is  often  of  ex- 
treme comfort  in  urticaria  or  lichen.  A  solution  of  the  same  strength, 
of  cyanide  of  potassium,  Avhich  has  also  a  strong  alkaline  reaction,  is, 
perhaps,  a  still  more  effective  application. 

The  itching  of  many  other  eruptions,  as  of  scabies,  eczema,  pruritus 
ani,  and  pruritus  vulvje,  and  prurigo  from  lice,  yield  more  readily  to 
other  applications,  Avhich  are  indicated  elsewhere. 

The  carbonates  of  tlie  alkalies  ai-e  employed  in  the  treatment  of  itch, 
either  in  soap,  or  in  the  form  of  ointment,  to  remove  the  superficial  and 
dead  cuticle,  aiul  so  to  break  up  the  burrows  of  the  itch  insect. 

By  virtue  of  the  alkali  it  contains,  soap  facilitates  the  removal  of  the 
scales  of  psoriasis. 


ALKALIES.  135 

In  the  treatment  of  eczema  a  weak  solution  of  carbonate  of  potash  or 
of  soda  finds  much  favor,  I  have  no  doubt  of  its  usefulness  in  the  early 
and  middle  stages  of  the  disease,  when  the  red  and  raw  surface  weeps 
copiously;  but  when  the  weeping  has  ceased,  and  especially  when  mere 
desquamation  remains,  the  alkali  fails  to  be  of  use,  and  other  applications 
are  preferable.  Dr.  Hughes  Bennett  recommends  a  solution  containing 
half  a  drachm  of  carbonate  of  soda  to  a  pint  of  water,  and  the  affected 
surface  to  be  kept  constantly  moist  by  a  thin  piece  of  lint,  soaked  in  the 
solution  and  covered  Avith  oilskin,  or  with  a  piece  of  lint  spread  with  sim- 
ple ointment.  A  weaker  solution  acts  sometimes  still  better.  Like  tbe 
oilskin,  the  ointment  prevents  evaporation,  but  is  less  "  heating  "  and  is 
more  comfortable  to  the  patient.  This  treatment  is  an  instance  of  the 
general  proposition  {vide  section  on  the  topical  action  of  alkalies  and  acids 
on  the  secretions)  that  alkalies,  as  local  applications,  check  an  alkaline 
secretion;  for  the  fluid  which  oozes  so  abundantly  from  eczematous  sur- 
faces is  strongly  alkaline,  and  an  alkaline  application  very  speedily  checks 
the  abundant  weeping. 

It  must  be  admitted,  however,  in  some  instances,  that  an  alkali  appears 
to  irritate  the  skin,  a  result  often  due  to  an  over-strong  solution.  During 
this  treatment  attention  must  be  paid  to  the  state  of  the  digestive  organs, 
and  any  irritation   produced  by  teething  or  worms  should  be  attended  to. 

It  is  sometimes  useful  to  wash  the  moist  and  weeping  eczematous 
surface  night  and  morning  with  soap  and  water,  which  in  many  cases 
checks  the  secretion,  and  allays  the  heat  and  irritation.  If  a  strong  soap 
is  too  irritating,  a  milder  one  must  be  used.  In  chronic  forms  of  eczema, 
Hebra  recommends  the  application  of  liqiior  potassas,  or  of  the  stronger 
solution  of  caustic  potash.  He  advises  that  liquor  potasste  should  be 
brushed  once  a  day  over  the  surface,  and  if  it  produces  much  smarting, 
the  residue  must  be  washed  off  with  cold  water.  When  the  skin  is  only 
slightly  infiltrated  and  tbickened,  he  employs  a  solution  composed  of  two 
grains  of  caustic  potash  to  an  ounce  of  water;  but  when  the  infiltration  is 
greater  he  uses  a  solution  containing  from  five  to  thirty  grains  or  more 
to»the  ounce.  These  stronger  applications  must  be  employed  only  once  a 
day,  and  must  be  quickly  washed  off  with  cold  water.  This  treatment 
speedily  allays  itching,  but  is  liable  to  make  the  skin  brittle,  and  to  obviate 
this  condition  Dr.  McCall  Anderson  applies  every  night  either  cod-liver 
oil  or  glycerine.  Dr.  Anderson  frequently  employs  alkalies  in  conjunc- 
tion with  tar  or  oil  of  cade.  He  recommends  the  following  prescription: 
— "  Equal  parts  of  soft  soap,  rectified  spirit,  and  oil  of  cade.  A  little  of 
this  to  be  firmly  rubbed  over  the  eruption  night  and  morning  and  washed 
off  before  each  re-application."  Mr.  Startin  condemned  the  use  of  soap 
in  eczema,  or  in  any  skin  disease,  using  instead  a  wash  consisting  either  of 
yolk  of  egg  and  water,  or  milk  and  water. 

Sponging  the  head  several  times  a  day  with  a  saturated  solution  of 
borax  and  water  is  an  effectual  application  in  pityriasis  of  the  scalp;  it  at 
once  eases  the  itching,  loosens  the  scales,  and  cleans  the  head.  Pityriasis 
often  gives  way  in  a  short  time  to  this  treatment;  although,  unfortunately, 
after  a  variable  period  the  affection  generally  returns,  which  indeed 
happens  when  the  disease  is  removed  by  other  treatment.  Should  the 
pityriasis  prove  rebellious  glycerine  of  borax  often  proves  more  useful,  as 
it  keeps  the  seal])  continually  moist  with  the  weak  alkaline  preparation. 
This  plan  is  useful,  too,  in  eczema  of  the  ears  and  scalp. 

Acne  punctata  generally  yields  to  hot  water  and  plenty  of  soap  several 


136 


ALKALIES. 


times  a  day,  a  treatment  Avhicli  keeps  open  the  orifices  of  the  sebaceous 
follicles  and  prevents  the  accumulation  of  the  abundant  secretion.  If  this 
treatment  roughens,  reddens,  and  irritates  the  skin,  it  should  be  Avell 
rubbed  with  glycerine  of  starch  after  each  washing. 

Free  ablution  with  soap  and  water  is  very  effective  in  decomposing 
and  removing  the  acid  irritating  secretions  wliich  keep  up  the  intertrigo 
so  often  infesting  the  buttocks  of  children,  or  in  the  irritation  in  the  folds 
of  the  skin  of  stout  children  or  underneath  the  breasts  of  fat  women. 
After  carefully  drying  the  parts,  they  should  be  smeared  over  with  some 
greasy  application,  which  is  generally  preferable  to  dusting  powders,  as 
starch  powder  or  oxide  of  zinc,  or  boracic  acid.  Caustic  potash  or  soda  is 
sometimes  used  to  open  abscesses  with  the  intention  of  preventing  scarring. 

Alkaline  baths  are  often  employed,  but  their  action  on  the  skin  and 
its  secretion  is  not  yet  satisfactorily  determined;  like  acid  or  simple  baths 
they  lessen  the  acidity  of  the  urine. 

Soap  with  excess  of  alkali  will  induce  pityriasis  of  the  face,  which  will 
often  disappear  at  once  on  substituting  oatmeal  or  a  milder  soap,  as 
*'  Compressed  glycerine  soap"  or  "  Solidified  glycerine." 

Mr.  Peppercorne  recommends  a  saturated  solution  of  carbonate  of  soda 
as  a  local  application  to  burns  and  scalds.  Cloths  dipped  in  the  solution 
are  applied  and  covered  with  oil  silk. 

A  weak  solution  of  bicarbonate  of  potash  or  soda,  a  drachm  of  the  salt 
to  a  pint  of  water,  is  a  useful  injection  to  check  leucorrhoea,  when  this 
discharge  depends  on  an  increased  secretion  of  the  glands  of  the  os  uteri. 
The  secretion  is  strongly  alkaline,  and  when  unduly  abundant,  the  effi- 
cacy of  the  alkaline  injection  in  such  cases  is  another  proof  of  the  general 
proposition  that  alkalies  check  alkaline  secretions. 

When  the  leucorrhoeal  discharge  is  clear,  like  white  of  egg,  or  when  it 
is  lumpy,  but  not  yellow,  three  or  four  injections  will  generally  check  it. 
On  the  other  hand,  when  the  discharge  is  yellow  and  puriform,  the  injec- 
tion may  fail;  although  in  many  cases,  when  this  yellow  discharge  is  due 
to  mere  abrasion  of  the  os  uteri,  the  injection,  continued  for  one  or  two 
weeks,  will  change  the  yellow  to  a  white  discharge,  and  sometimes  cai^se 
even  this  to  disappear.  If  the  leucorrhoea  is  produced  by  displacement 
of  the  uterus,  or  ulceration  of  its  neck,  this  injection,  like  many  others, 
may  temporarily  check  the  discharge;  but  it  soon  returns,  and  in  such 
cases  the  leucorrhoea  cannot  be  cured  till  these  conditions  are  removed. 

The  success  of  this  injection  obviously  depends  on  its  reaching,  and 
coming  well  in  contact  with,  the  os  uteri,  the  offending  part;  hence  it  is 
necessary  to  give  full  and  careful  directions  as  to  its  use.  The  patient 
should  be  directed  to  lie  on  her  back,  to  raise  the  buttocks  by  placing  a 
pillow  under  them,  and  then  to  introduce  the  syringe  as  far  as  she  con- 
veniently can,  and  to  leave  the  injection  in  the  vagina  about  five  minutes. 
The  injection  should  be  used  cold,  Avlien  it  can  be  borne,  twice  or  three 
times  in  the  day.  A  Kennedy's  syringe,  by  means  of  which  any  quantity 
of  lotion  may  be  forcibly  injected,  and  which,  by  washing  away  the  dis- 
charges and  douching  the  part  with  a  cold  or  warm  medicated  application, 
is  even  more  effectual. 

Mr.  Norton,  of  St.  Mary's  Hospital,  ingeniously  employs  a  solution  of 
liquor  potassge  (two  drachms  to  the  ounce  of  water)  in  the  treatment  of 
ingrowing  toe-nail.  ''Apiece  of  cotton-wool  is  saturated  with  the  solu- 
tion, and  pressed  gently  down  between  the  upper  surface  of  the  nail  and 
the  soft  tissues.     The  solution  permeates  the  substance  of  the  nail,  and 


ALKALIES.  137 

softens  and  pulpetizes  the  superficial  cells.  The  wool  is  kept  constantly 
moist  with  the  lotion,  and  softened  tissues  are  wiped  away  each  morning. 
The  nail  in  a  few  days  becomes  thin  and  flexible,  and,  if  desired,  it  can 
be  pared  away  without  pain.  The  lotion  should  be  continued  until  all 
ulceration  has  disappeared." 

liorax  is  antiseptic,  and  prevents  fermentation  and  putrefaction.  It 
coag'ulates  yeast,  and  destroys  its  power  to  decompose  sugar  into  alcohol. 
It  destroys  the  action  of  diastase  or  amygdalin,  and  so  prevents  the  for- 
mation of  essence  of  bitter  almonds  and  prussic  acid,  and  the  conversion 
of  starch  into  glucose.  It  also  destroys  the  action  of  myrosine,  and 
prevents  the  formation  of  the  pungent  essence  of  mustard  from  the 
mustard  farina. 

Sir  J.  Simpson  recommended  borax  in  "the  pruriginous  eruption 
which  appears  on  the  mucous  membrane  of  the  vulva,  and  extends  up 
along  the  vagina  as  far  as  the  cervix  uteri.  It  may  also  extend,  and  is 
sometimes,  indeed,  originally  situated  on,  the  cutaneous  border  of 
the  vulva,  and  appears  on  the  outer  cutaneous  surface  of  the  labium, 
spreading  backwards  along  the  perinteum  to  the  circle  of  the  anus.  Ac- 
cordingly it  is  a  flitting  and  transient  affliction,  recurring  with  menstrua- 
tion, pregnancy,  or  delivery.  It  may  be  more  fixed,  and  last  weeks,  or 
months,  or  years,  producing  constant  irritation  and  distress,  frequently 
interfering  with  rest  and  sleep,  and  rendering  the  victims  miserable  and 
almost  deranged  when  the  disease  has  become  somewhat  chronic,  and 
necessitates  the  patient  to  attempt  to  alleviate  it  by  constant  and  some- 
times rough  friction.  The  mucous  membrane  becomes  at  the  most  irrita- 
ble parts  white,  and  thickened  with  red  fissures."  This  distressing  com- 
plaint, says  Sir  J.  Simpson,  "  may  be  generally  cured  by  the  assiduous 
and  persevering  application  of  a  solution  of  biborate  of  soda  (five  or  ten 
grains  to  the  ounce  of  water)."  A  hot  solution  much  enhances  the  effi- 
cacy of  borax.  Water  alone,  as  hot  as  can  be  fairly  borne,  will  often  allay 
this  itching;  but  hot  water  with  borax  is  far  more  efficacious.  If  this 
treatment  fail,  infusion  of  tobacco  may  be  tried;  or  an  ointment  of  iodide 
of  lead  (  3  i.  to  §1.),  or  of  bismuth  and  morphia.  Chloroform  vapor, 
liniment,  or  ointment,  is  often  found  useful;  a  drachm  of  chloroform 
may  be  added  to  an  ounce  of  some  sedative  liniment  or  ointment.  A 
strong  lead  lotion  or  a  solution  of  nitrate  of  silver  often  does  good.  Dr. 
Simpson  says,  "  There  is  a  great  advantage  in  alternating  these  local  ap- 
plications; for  most  of  them  begin  to  lose  their  effects  when  persevered 
in  above  a  few  days.  In  the  most  obstinate  and  severe  cases  strong  astrin- 
gents are  sometimes  of  the  greatest  use,  as  a  strong  solution  of  alum  or 
tannin. " 

Dr.  Garrod  employs  strong  solutions  of  lithia  salts  to  remove  gouty 
enlargements.  Gout-stones  are  composed  of  urates.  Urate  of  lithia 
being  the  most  soluble  of  uric  acid  salts,  a  strong  solution  of  a  lithia  salt 
is  applied  with  the  intention  of  converting  the  urates  in  the  tissues  into 
urate  of  lithia,  and  so  to  soak  the  urates  out  through  the  skin.  The 
swelling  must  be  constantly  enveloped  in  lint  or  rag  kept  moist  with  the 
lithia  solution.  In  Dr.  Garrod's  practice  this  treatment  has  proved  very 
successful.  He  thinks  that  lithia  salts  formed  Avitli  the  uric  acid  pass 
into  the  blood,  and  that  in  this  way  gout-stones  are  reduced.  He  employs 
carbonate  of  lithia,  five  grains  to  the  ounce,  with  which  he  has  removed 
considerable  enlargements  and  restored  suppleness  and  even  free  move- 
ment to  stiff  and  useless  joints.     I  also  have  employed  this  treatment  with 


138  ALKALIES. 

considerahlo  success.  It  is  especially  useful  when  the  skin  is  broken  over 
the  gouty  enlargement.  It  is  well  known  that  a  sore  of  this  kind  is  ex- 
tremely difficult  to  heal.  The  urates  being  ultimately  mixed  with  the 
connective  tissue,  and  oozing  very  slowly  through  the  wound,  are  dissolved 
and  washed  away  by  the  lithia  solution,  thus  enabling  the  sore  to  heal. 
The  citrate  of  lithia  is  to  be  preferred;  but  a  strong  solution  of  citrate  of 
potash  is  nearly,  if  not  quite,  as  useful.  It  probably  converts  the  biurates 
into  neutral  urates,  and  in  this  more  soluble  form  the  urates  are  carried 
off  through  the  skin.  Equal  jmrts  of  citrate  of  potash  and  water  may  be 
used.  Neither  the  solution  of  citrate  of  lithia,  nor  that  of  citrate  of 
potash,  irritates  the  skin.  As  might  be  expected,  this  treatment  takes 
many  weeks,  or  even  months,  to  effect  considerable  reduction  of  large 
deposits. 

Kappesser  has  drawn  attention  to  the  value  of  soft-soap  as  an  applica- 
tion to  scrofulous  enlargements  and  in  acute  and  chronic  inflammations, 
and  Beetz  and  Senator  confirm  and  supplement  his  recommendation.  It 
is  useful  in  scrofulous  enlargements,  lymphadenitis,  subcutaneous  inflam- 
mation, as  abscesses  and  whitlow;  also  in  chronic  glandular  enlargements 
or  abscesses.  Soft-soap  is  applied  each  night  and  rubbed  off  next  morn- 
ing, or  linen  rags  soaked  in  a  solution  of  soft-soap  3  ij. ;  alcohol  or  eau 
de  Cologne  3  j.  It  has  been  used  successfully  in  scrofulous  mesenteric 
disease,  caries  and  periostitis.  In  caries  and  periostitis  about  fifteen 
grammes  of  green  soap  is  rubbed  over  the  part,  and  in  half  an  hour  is 
washed  off.  Senator  finds  soft-soap  inunctions  useful  in  chronic  non- 
scrofulous  glandular  enlargements,  syphilitic  glandular  swellings,  and  in 
serous  exudations,  including  exudations  into  synovial  cavities. 

Borax  and  honey,  or  the  gh'cerine  of  borax,  is  often  used  for  aphthfe. 
In  aphthffi  the  mucous  membrane  is  usually  covered  with  small,  round, 
sharply-cut  superficial  ulcers,  covered  with  a  pultaceous  exudation. 
AphthfB  natnrally  runs  a  short  course,  and  when  left  untreated  gets  well 
in  most  cases  in  a  week  or  ten  days.  The  same  preparations  are  useful 
in  removing  the  curdy  exudation  of  thrush. 

Dr.  Corson  finds  that  a  piece  of  borax  the  size  of  a  pea,  dissolved  in 
the  mouth,  acts  magically  in  restoring  the  voice,  in  cases  of  sudden  hoarse- 
ness brought  on  by  a  cold,  and,  frequently,  for  an  hour  or  so,  it  renders 
the  voice  ' '  silvery  and  clear. " 

Borax  is  useful  in  hoarseness  common  among  clergymen  and  singers. 

The  action  of  the  members  of  this  group  on  the  stomach  was  some- 
what anticipated  Avhen  it  was  shown  that  alkalies  increase  the  secretion 
of  the  gastric  juice,  and  may  thus  prove  useful  to  promote  digestion.  It 
is  obvious,  however,  that  method  must  be  observed,  or  the  contrary  effect 
to  that  intended  will  ensue;  for,  if  given  soon  after  a  meal,  the  alkalies 
will  neutralize  the  acid  of  the  gastric  juice,  and  effectually  retard  and  im- 
pede digestion.  Alkalies  intended  to  increase  the  quantity  of  gastric 
juice,  and  to  promote  digestion,  mnst  be  taken  a  short  time  before  a  meal. 
The  alkaline  saliva  swallowed  at  the  beginning  of  a  meal  is  highly  useful; 
although,  as  it  must  speedily  become  neutralized  by  the  acids  of  the  stom- 
ach, its  action  must  be  but  temporary.  Alkalies  may  be  usefully  admin- 
istered in  many  forms  of  atonic  dyspepsia,  and  in  other  forms  associated 
with  deficient  secretion  of  the  gastric  juice.  The  bicarbonate  of  soda  is 
the  salt  generally  employed. 

\Yhen,  on  the  other  hand,  a  patient  complains  of  heartburn  and  acid 
eructations,  these  disagreeable  symptoms  may  at  once  be  removed  by  the 


ALKALIES.  139 

exliibition  of  an  alkali,  as  tlie  bicarbonate,  wliicli  neutralizes  the  excess 
of  acid  in  the  stomach;  but  it  must  alwa3^s  be  remembered  that  this  treat- 
ment is  merely  palliative.  No  doubt  a  course  of  alkaline  treatment 
appears  sometimes  to  remove  acidity;  but  the  good  attributed  to  alkalies 
may  with  great  probability  be  ascribed  to  the  tonic  with  which  they  are 
generally  combined.  The  bicarbonates  are  preferred  to  the  more  caustic 
salts  on  account  of  their  milder  action,  while  the  acetates  and  citrates  are 
neutral,  becoming  alkaline  only  by  decomposition  in  the  intestines  or 
blood.  The  bicarbonates  being  milder  can  be  continued  longer  than  the 
more  caustic  preparations;  but  they  have  the  disadvantage  of  giving  off 
much  carbonic  acid  gas,  which  may  cause  trouble  from  distention  of  the 
stomach.  To  prevent  this,  magnesia,  which  is  an  alkali,  and  acts  like 
the  members  of  this  group,  mtiy  be  substituted  if  the  bowels  are  confined, 
or  lime-water  if  they  are  relaxed. 

Alkalies  are  apparently  sedative  to  the  stomach,  at  least  they  often 
relieve  the  pain  of  this  organ.  Liquor  potassaj  is  generally  employed  in 
such  cases. 

In  cases  of  poisoning  by  any  of  the  acids,  alkalies  the  least  irritating  to 
the  stomach  are  employed  to  neutralize  and  to  prevent  the  further  action 
of  the  acid  on  the  tissues. 

In  poisoning  by  metallic  salts  and  alkaloids  the  same  salts,  namely, 
the  bicarbonates  of  the  alkalies,  may  be  used,  to  precipitate  the  insoluble 
oxide  of  the  metal  or  of  alkaloids.  Magnesia,  as  it  acts  as  a  slight  purga- 
tive, and  so  helps  to  expel  the  poison  from  the  intestinal  canal,  is  gener- 
ally preferred. 

By  virtue  of  their  diffusion-power,  the  substances  contained  in  this 
group  pass  so  readily  into  the  blood,  that  but  a  small  portion  of  them 
reaches  far  into  the  small  intestines.  Little  is  known  of  their  action  on 
the  small  intestines,  and  on  the  organs  which  pour  their  secretion  into 
them;  yet  it  seems  probable  that  those  secretions  having  an  alkaline  re- 
action may  be  affected  in  a  double  and  opposite  way,  according  to  the 
period  of  administering  these  drugs.  The  secretion  from  the  intestinal 
glands  is  alkaline;  hence,  if  the  general  propositioii  elsewhere  formulated 
be  valid,  acids  ap]5lied  to  the  orifices  of  the  ducts  should  augment  their 
secretion,  while  alkalies  should  have  the  contrary  effect.  But  we  have 
seen  that  alkalies,  given  before  meals,  increase  the  secretion  of  the  acid 
gastric  juice,  and  thus  augment  the  acidity  of  the  intestinal  canal;  they 
should  likewise  increase  the  biliary  and  pancreatic  secretion.  On  the 
other  hand,  if  given  after  a  meal,  alkalies  neutralize  the  acid  in  the  stom- 
ach, and  should  lessen  the  secretion  from  the  liver  and  pancreas.  On 
these  points,  however,  nothing  is  known  with  certainty,  the  foregoing 
statements  being  merely  conjectural. 

Rutherford,  from  his  experiments,  concludes  that  bicarbonate  of  soda 
injected  into  the  duodenum  of  fasting  dogs  "  has  scarcely  any  effect  on 
the  secretion  of  bile." 

The  milder  alkalies,  as  bicarbonates  of  potash,  soda,  or  magnesia,  may 
be  used  with  great  benefit  in  diarrhoea,  caused  by  excess  of  acid  in  the 
intestines.  By  neutralizing  the  excess  of  acid,  these  substances  arrest 
the  diarrhoea. 

Soap  is  often  added  to  anal  injections,  to  suspend  castor-oil  or  turpen- 
tine. Soap  itself,  moreover,  may  be  used  as  a  mild  and  safe  purgative. 
A  piece  the  size  of  the  thumb,  covered  with  castor-oil  or  merely  wetted 
with  water,  and  thrust  up  the  rectum  as  high  as  the  finger  will  carry  it. 


140  ALKALIES. 

in  a  short  time  will  produce  an  easy,  copious,  and  natural  evacuation. 
This  plan  is  especially  available  for  infants  and  children. 

On  entering  the  blood,  alkalies  undergo  various  changes,  according 
to  their  composition.  The  acetate  or  citrate,  which  has  not  already  under- 
gone a  like  change  in  the  intestines,  becomes  converted  into  the  carbonate, 
the  form  probably  ultimately  assumed  by  the  oxide  of  the  alkalies. 

The  alkalinity  of  the  blood  must  therefore  be  increased  by  these  alka- 
lies, not  probably  to  any  great  extent,  as  from  their  high  diffusion-power 
they  are  rapidly  eliminated  by  the  kidneys.  There  has  been  much  specu- 
lation concerning  this  increase  in  the  alkalinity  of  the  blood.  The  alka- 
lies are  known  to  promote  oxidation,  whence  it  has  been  conjectured  that 
its  oxidation,  and  that  of  the  tissues,  may  be  increased  by  increasing  the 
alkalinity  of  the  blood.  It  has  been  suggested  that  alkalies  might  be 
profitably  employed  in  diabetes  to  promote  the  oxidation  of  the  sugar. 
Alkalies  have  been  advocated  also  for  excess  of  uric  acid  in  the  urine, 
with  the  expectation  of  oxidizing  this  product  of  the  nitrogenous  tissues, 
and  so  converting  it  into  urea  or  some  other  substance.  Alkalies  are 
sometimes  given  to  fat  people  to  increase  oxidation,  in  order  to  consume 
the  superfluous  fat,  and  so  to  control  unseemly  obesity.  The  solutions 
of  the  bicarbonates,  and  especially  of  the  oxides,  are  occasionally,  and  I 
should  think  unsuccessfully,  used  for  this  purpose. 

The  action  of  alkalies  in  diabetes  appears  to  be  nil,  or  rather,  it  should 
be  said,  they  in  no  degree  lessen  the  amount  of  sugar  separated  by  the 
kidneys,  although,  if  long  persisted  in,  some  derangement  of  the  stomach 
must  occur,  with  diminution  in  appetite,  so  that  less  food  being  taken, 
less  sugar  is  excreted. 

Nor  does  it  appear  that  alkalies  can  oxidize  uric  acid  in  the  blood;  at 
least  there  are  no  experiments  in  proof  of  this.  It  is,  however,  very  use- 
ful to  give  alkalies,  so  as  to  render  the  urine,  weakly  acid,  or  even  alkaline, 
so  as  to  convert  the  excessive  quantity  of  uric  acid  into  a  more  soluble 
urate.     This  treatment,  too,  will  prevent  the  growth  of  uric  acid  calculi. 

Micturition  in  young  male  children  not  unfrequently  causes  severe 
pain,  traced  to  thci  existence  of  uric  acid  or  biurates,  in  the  form  of  spicu- 
lar  crystals,  which  in  their  passage  irritate  the  urethra.  By  alkalinizing 
the  urine,  these  crystals  are  dissolved  and  rendered  innocuous.  The 
citrates  having  very  little  action  on  the  mucous  membrane  of  the  stomach, 
are  the  salts  best  adapted  to  deacidize  the  urine. 

As  to  the  jiower  of  alkalies  to  increase  the  oxidation  of  fats,  it  is  clear 
that  the  long-continued  administration  of  the  more  alkaline  preparations 
will  induce  much  wasting  of  the  body,  and  admits  of  no  doubt,  but  this  is 
effected  by  the  disordering  action  on  the  mucous  membrane  of  the  stomach. 

To  diminish  fatness  in  a  way  so  likely  to  damage  health,  and  even  to 
endanger  life,  is  surely  a  mistake.  Some  writers  of  authority  insist  that 
obesity  may  be  thus  reduced  without  any  ill  effects  on  the  mucous  coat 
of  the  stomach;  Dr.  Neligan  states  that  he  has  often  removed  an  uncom- 
fortable excess  of  fat  by  the  use  of  liquor  potassa?,  Avithout  in  any  way 
injuring  the  patient's  general  health.  Though  occasionally  successful, 
this  treatment  generally  fails  signally. 

After  the  passage,  of  alkalies  into  the  blood,  and  their  conversion  into 
carbonate,  the  action  of  these  substances  on  that  fluid  is  at  present  l)ut 
little  knoAvn.  Dr.  Garrod  is  of  opinion  that  scurvy  is  due  to  deficiency  of 
potash  salts  with  the  food,  a  surmise  supported  by  many  facts,  but  not 
yet  confirmed  by  exact  observation. 


ALKALIES.  141 

Eossbacli,  in  his  experiments  on  animals,  finds  that  alkalies  acting 
through  the  blood  dry  up  the  normal  secretion  of  the  bronchial  mucous 
membrane.  The  reverse  of  this  happens,  therapeutically,  when  alkalies 
are  given  in  chronic  bronchitis  with  viscid,  scanty  expectoration;  for  then 
alkalies  increase  secretion  and  lessen  viscidity.  Eossbacli  in  his  experi- 
ments used  very  large  quantities  of  alkalies,  and  this  excess  may  explain 
his  results. 

The  bicarbonate  or  citrate  of  potash  is  often  employed  in  rheumatism. 
This  disease  is  supposed  to  be  produced  by  an  excessive  formation  of  lactic 
acid,  which,  having  an  afhnity  for  certain  tissues  of  the  body,  excites  in 
them  the  rheumatic  inflammation.  Alkalies  are  given  to  neutralize  this 
acid,  and  to  protect  the  tissues  from  its  action.  But  so  little  is  known 
about  the  nature  of  rheumatism,  that  it  is  impossible  to  approach  the 
question  of  its  treatment  on  the  theoretical  side.  As  careful  and  exact 
observations  of  this  treatment  are  non-existent  we  can  only  be  influenced 
by  individual  impression.  This  much,  however,  must  be  conceded,  that 
in  many  cases  rheumatic  pain  is  much  relieved  as  soon  as  the  patient  is 
well  under  the  action  of  an  alkali  and  the  urine  has  ceased  to  be  acid. 

Many  eminent  authorities  are  firmly  convinced  that  the  alkaline  treat- 
ment renders  rheumatic  fever  both  milder  and  shorter,  and  diminishes 
the  danger  of  heart  complications.  I  have  made  many  careful  observa- 
tions on  this  question,  and  am  led  to  believe  that,  due  attention  being 
paid  to  the  age  of  the  patient,  and  to  the  nature  of  the  rheumatism,  it 
will  be  found  that  these  salts  are  unavailing  either  to  lessen  the  intensity 
or  the  duration  of  the  fever. 

In  the  fifty-second  volume  of  the  Medico-Cliirurcjlcal  Transactions, 
Drs.  Gull  and  Sutton  published  a  paper  on  the  value  of  remedies  in  rheu- 
matic fever.  The  cases  quoted,  although  not  numerous  enough  to  settle 
this  much-vexed  question,  lead  them  to  the  conclusion  that  alkalies, 
lemon- juice,  or  blistering,  do  not  shorten  the  course  of  rheumatic  fever, 
but  it  is  not  denied  that  these  remedies  may  allay  pain.  They  further 
conclude  that  neither  alkalies,  lemon-juice,  nitrate  of  potash,  nor  blis- 
ters, prevent  the  occurrence  of  heart  disease  in  rheumatic  fever.  In 
dealing  with  statistics  relating  to  the  treatment  of  rheumatism  it  is  neces- 
sary to  be  specially  cautious;  the  present  tendency,  warranted  by  observa- 
tion, leads  to  the  conviction  that  hereafter  rheumatism  will  be  discrimi- 
nated into  many  varieties.  Already  we  have  distinctive  rheumatic  fevers, 
due  not  only  to  weather  influence,  but  to  syphilis,  lead,  etc. ,  and  it  is  often 
difficult,  and  at  first  even  impossible,  to  distinguish  gonorrhoeal  rheuma- 
tism and  acute  febrile  rheumatoid  arthritis  from  rheumatic  fever.  In 
rheumatism  there  is  a  large  unworked  field  of  inquiry. 

The  influence  of  age,  too,  in  acute  rheumatism  must  be  taken  into 
account.  Thus  in  children  the  attack  is  sharp  and  short,  declining  even 
when  untreated  in  from  five  to  ten  days;  and,  wliilst  the  danger  to  the 
heart  is  much  greater  than  with  adults,  the  joint  affection  is  so  slight  that 
in  an  acute  attack,  with  a  temperature  varying  between  103  and  10-4,  the 
child  may  not  even  complain  of  joint-pain,  or  complain  so  slightly  that  the 
nature  of  the  case  may  easily  be  overlooked. 

Fever  in  a  child,  with  even  the  slightest  pains  in  the  joints,  leads  us 
to  investigate  carefully  if  we  have  not  to  deal  with  an  attack  of  acute 
rheumatism.  On  the  other  hand,  in  middle-aged  and  old  people,  slight 
fever  is  generally  accompanied  by  severe  pain  in  many  joints,  whilst  the 
danger  to  the  heart  is  almost  nil,  and  the  attack  is  often  chronic.     Again, 


142  ALKALIES. 

the  fatality  of  rheumatism  is  much  influenced  hy  age.  Rheumatic  hyper- 
pyrexia, the  most  common  cause  of  death  in  acute  rlieumatism,  rarely 
occurs  in  children  or  in  middle-aged  people.  Children  rarely  die  of  acute 
rlieumatism — indeed,  I  have  never  seen  a  child  die  of  this  disease.  The 
foregoing  observations  make  it  obvious  that,  in  testing  the  efficacy  of 
remedies,  we  must  take  care  not  only  to  discriminate  one  kind  of  rheuma- 
tism from  another,  but  to  compare  cases  occur ing  in  persons  of  much  the 
same  age. 

The  frequency  of  relapse  in  acute  rheumatism  is  well  recognized.  I 
believe  this  relapse  is  in  many  cases  explicable  and  avoidable.  Thus  I 
have  found  that  when  the  temperature  has  become  nearly  normal,  rising 
only  to  99.5  to  100,  or  a  little  over,  there  maybe  no  pain,  especially  in 
the  case  of  a  child,  and  the  patient  feels  so  well  that  he  is  often  allowed 
to  get  up  and  walk  about,  at  the  great  risk  of  bringing  back  the  fever  and 
joint- pain.  In  the  ward  I  have  frequently  verified  the  fact  that  relapses 
are  often  brought  about  in  this  way,  and  I  am  sure  it  is  much  siifer  to 
take  care  that  the  temperature  should  become  normal,  and  remain  so  for 
several  days,  before  the  j^atient  is  allowed  to  get  up.  These  cases  will 
illustrate  the  importance  of  the  thermometer,  as  so  slight  a  degree  of  fever 
is  quite  indetectable  by  the  hand.  But  the  temperature  must  be  taken 
several  times  a  day,  as  the  preternatural  rise  may  last  only  a  few  hours 
daily.  Movement  of  the  joints  in  rheumatic  fever  inflames  them  and 
heightens  the  fever.  If  a  joint,  free  from  inflammation  and  pain,  is 
Avorked  by  the  hand  for  a  short  time,  it  often  becomes  in  a  few  hours 
acutely  painful  and  red.  Again,  it  is  well  known  that  the  journey  to  the 
hospital  often  excites  inflammation  in  patients'  joints  and  heightens  the 
fever,  so  that  simple  rest  during  the  few  first  days  in  the  ward  almost 
always  causes  a  diminution  of  pain  and  fever. 

Potash  salts  exist  abundantly  in  the  milk,  Avhence  it  has  been  sug- 
gested that  the  administration  of  these  salts  may  promote  this  secretion. 

The  sustained  administration  of  the  alkalies  and  their  carbonates  ren- 
ders the  blood,  it  is  said,  poorer  in  solids  and  in  red  corpuscles,  and  im- 
jiairs  the  nutrition  of  the  body.  These  results  are  probably  due  to  disor- 
dered digestion,  produced  by  the  long-continued  use  of  alkalies,  and  are 
not  dependent  on  an  excess  of  alkalinity  of  the  blood.  Such  excess  must 
always  be  slight  on  account  of  the  ra])id  elimination  of  these  salts  by  the 
kidneys.  It  has  been  shown  by  Sir  \V .  Koberts  that  the  citrate  of  potash 
may  be  taken  for  an  almost  indefinite  time  without  deranging  the  gen- 
eral health,  yet  this  drug  increases  the  alkalinity  of  the  blood,  while, 
owing  to  its  neutral  reaction,  it  is  harmless  to  the  stomach. 

Liquor  potassa3  bears  the  reputation  of  promoting  the  absorption  of  in- 
flammatory formations,  and  is  occasionally  employed  in  pleuris}',  but 
its  good  effects  are  not  evident,  and  the  disorder  it  produces  in  the  stom- 
ach renders  its  use  unadvisable  for  any  length  of  time.  Dr.  Walshe 
recommends  liquor  potass^  in  plastic  bronchitis. 

Carbonate  of  potash,  in  one  or  two  grain  doses,  given  three  or  four 
times  daily,  with  a  little  syrup  to  cover  the  taste,  is  much  used  in  Phila- 
delphia for  whooping-cough. 

Sodium  bicarbonate,  ten  to  fifteen  grains  to  the  ounce  of  water,  read- 
ily dissolves  false  membrane,  as  of  diphtheria,  and  this  solution  is  at 
present  largely  used  as  a  local  application  to  the  throat  and  to  the  trachea 
and  larynx,  through  the  wound  after  tracheotomy. 

AVliat  influence  have  the  alkalies  on  tissue  change  ?     Dr.  Parkes  has 


ALKALIES.  148 

investigated  the  action  of  liquor  potassse,  and  lie  thinks  that  it  probably 
increases  the  disintegration  of  the  nitrogenous  substance  of  the  body.  He 
believes  that  his  experiments  justify  him  in  concluding  that  it  disintegrates 
also  the  sulphur-holding  tissues,  for  liquor  potasste  increases  both  the  urea 
and  the  sulphuric  acid  of  the  urine.  The  strong  reaction  of  liquor  potas- 
s£e  unfits  it  to  be  given  in  doses  sufficiently  large  to  affect  in  any  great 
degree  the  reaction  of  the  urine,  so  that  when  it  is  required  to  alkalinize 
this  fluid  the  bicarbonates  or  citrate  must  be  employed. 

Large  doses  of  potash  salts  considerably  depress  the  temperature. 
Eecent  experiments  by  Feltz  and  Ritter  and  Astaschewsky  support  the 
idea  that  uraemia  is  due  to  the  retention  in  tlie  blood  of  potash  salts. 
They  tied  the  renal  arteries  of  animals,  and  injected  various  substances 
into  the  blood,  amongst  others  potash  salts,  and  produced  uremic  symp- 
toms. ,Drs.  Wood  and  Reichert  find  that  potash  salts  increase  about 
equally  both  heat  formation  and  heat  dissipation  through  the  skin. 

What  action  have  alkalies  on  the  constitutents  of  the  urine  ?  They 
are  all  reputed  to  be  diuretic,  but,  as  no  exact  observations  have  been 
made  with  these  salts,  this  statement  must  be  regarded  as  only  a  probable 
assumption. 

Before  referring  to  the  presumed  diuretic  properties  of  these  sub- 
stances, it  Avill  be  well  to  digress  for  a  short  space  to  speak  in  general 
terms  of  diuretics. 

By  diuretics,  we  understand  medicines  which  act  as  eliminators  of  the 
urine;  and  we  must  distinguish  diuretics  from  those  medicines  which,  by 
promoting  tissue  change,  cause  an  increase  in  any  of  the  constituents 
of  the  urine.  Diuretics  merely  separate  from  the  system  already-existing 
products. 

As  the  urine  is  a  complex  fluid  containing,  besides  water,  many  salts 
and  other  ingredients,  we  may  have  medicines  which  will  eliminate  one 
or  more  of  these  substances,  leaving  the  rest  unaffected.  We  may  there- 
fore have  diuretics  of  water,  or  of  urea,  or  of  uric  acid,  etc.  The  reten- 
tion in  the  blood  of  materials  which  should  be  eliminated  by  the  kidneys 
may  be  due  to  a  variety  of  conditions.  The  physical  state  of  the  kidneys 
may  be  altered,  and  these  organs  disabled  by  diseases  of  distant  organs,  as 
of  the  heart.  Or,  through  insufficient  oxidation  and  combustion  of  the 
effete  products  of  disintegration,  refuse  materials  may  remain  in  a  form 
unexcretable  by  the  kidneys;  and,  lastly,  the  retention  of  the  urinary 
ingredients  in  the  blood  may  be  dependent  on  organic  disease  of  the  kid- 
neys themselves. 

Thus,  in  one  instance,  a  medicine  acting  on  some  organ  at  a  distance 
from  the  kidneys,  as  the  heart  or  lungs,  will  be  a  diuretic;  while  in 
another,  those  means  which  promote  oxidation  in  the  blood  will  prove 
diuretic;  and,  lastly,  diuretics  may  act  immediately  on  the  kidneys  by  re- 
moving or  altering  those  physical  conditions  which  hinder  the  action  of 
those  organs. 

How  far  do  the  members  of  this  group  act  as  diuretics  ?  and  in  which, 
of  the  foregoing  ways?  We  cannot  give  very  satisfactory  answers  to  these 
questions. 

First,  as  to  their  diuretic  action. 

It  is  generally  held  that  all  these  substances  are  diuretic,  and,  under 
certain  circumstances,  they  may  possibly  become  so.  Acetate  of  potash 
and  acetate  of  soda  enjoy  the  highest  repute  in  this  respect,  though  some 
careful  observations  have  been  made  with  these  substances  on  persons  in 


144  ALKALIES. 

health,  which  have  led  to  unexpected  results.  It  was  found  ])y  Bocker 
(quoted  hy  Parkes),  "that  so  far  from  acting  as  a  diuretic  in  health,  the 
acetate  of  potash  diminished  the  Avater,  the  urea,  the  extractives,  and,  in  a 
remarkable  manner,  the  earthy  salts."  Some  valuable  observations  con- 
cerning the  action  of  citrate  of  potash  and  acetate  of  potash,  as  diuretics 
in  health,  have  been  made  by  Dr.  Nunneley  on  himself.  He  took  daily, 
for  twelve  days,  three  to  five  drachms  of  citrate  of  potash.  On  an  aver- 
age, the  daily  excretion  of  Avater  was  increased  by  two  ounces  and  a  half, 
but  the  urea  was  lessened  by  eighty-four  grains,  and  the  solids  by  sixty 
grains.  The  acetate  of  potash,  in  daily  doses  of  from  two  and  a  half  to 
three  and  a  half  drachms,  exerted  a  similar  influence  in  a  somewhat  less 
degree. 

But  should  we  expect  medicines  to  act  as  diuretics  or  eliminators  in 
healthy  persons?  In  their  blood  there  should  be  but  little  urea, or  uric 
acid  to  be  eliminated,  and  we  must  be  careful  how  far  Ave  alloAv  physio- 
logical experiments  on  healthy  subjects  to  guide  us  as  to  the  action  of 
diuretics  in  disease.  That  such  caution  is  highly  necessjiry  is  shown  by 
the  experiments  of  Ranke,  who,  after  giving  acetate  of  potash,  noticed 
a  very  considerable  increase  in  the  quantity  of  urine  voided  soon  after, 
shoA\-ing  that  this  salt  will  sometimes  act  as  a  diuretic  of  Avater. 

So  far  as  to  their  diuretic  properties;  and  we  Avill  endeavor  now  to 
answer  the  second  part  of  the  foregoing  question — In  what  Avay  do  they 
act  as  diuretics  ? 

It  is  not  supposed  that  any  members  of  this  group  act  on  organs  re- 
mote from  the  kidneys.  They  may  possibly  promote  oxidation  in  the 
blood,  and  so  reduce  effete  products  to  urea,  in  Avhicli  form  they  are 
separated  by  the  kidneys. 

Some  of  the  alkalies  are  considered  to  be  febrifuge,  as  the  citrates 
and  acetates.  If  so,  they  Avould  act  as  eliminators  of  Avater,  as,  on  the 
decline  of  fever,  an  increase  takes  place  of  the  urinary  Avater  previously 
held  back  in  the  system  during  the  febrile  state,  and  often  accompanied 
by  a  simultaneous  increase  in  the  solids  of  the  urine.  If,  therefore,  these 
substances  Avill  check  fcA'er,  this  increase  of  water  and  solids  must,  in 
some  measure,  be  due  to  their  action. 

These  alkalies  are  generally  reputed  to  act  as  diuretics  when  the  kid- 
neys are  diseased,  the  citrates  and  acetates  being  given  in  acute  and 
chronic  Bright's  disease.  By  making  the  urine  alkaline,  some  consider  it 
is  enabled  to  dissolve  the  organic  but  diseased  matters,  Avhich  block  up 
the  uriniferous  tubes  in  Bright's  disease,  and  hinder  the  secretion  of  the 
kidneys. 

It  has  already  been  mentioned,  that  the  members  of  this  group  render 
the  urine  less  acid,  or  even  alkaline;  but,  strange  to  say,  the  amount  of 
acid  excreted  Avitli  the  urine  is  actually  increased,  but  being  neutralized 
by  the  alkalies,  it  gives  no  acid  reaction. 

The  citrates  and  bicarbonates  are  constantly  employed  to  render  the 
urine  alkaline,  Avhen  the  urinary  organs  are  irritated  or  inflamed,  as  in 
cystitis  and  gonorrhoea.  If  in  cystitis,  the  urine,  before  it  is  passed,  is 
already  alkaline  from  decomposition  of  the  urea,  alkalies  must  be  inter- 
mitted; for  they  Avould,  of  course,  increase  the  alkalinity,  and,  as  alkaline 
decomposes  much  more  readily  than  acid  urine,  they  Avould  still  furtlier 
promote  the  decomposition  of  urea,  and  the  formation  of  carbonate  of 
ammonia. 

AVhen  excess  of  uric  acid  occurs  in  the  urhie,  it  should  be  kept  for  a 


ALKALIES.  145 

time  alkaline.  By  many  careful  and  ingenious  experiments,  Sir  W. 
Roberts  has  shown  that  uric  acid  calculi  may  probably  be  dis- 
solved in  the  bladder  if  the  urine  is  maintained  alkaline  for  some  weeks. 
This  treatment  is  probably  useful  in  renal  calculus,  which  is  generally 
composed  of  uric  acid  only.  It  is  reasonable  to  expect  that  the  alkaline 
urine  would  in  time  reduce  the  calculus  sufficiently  to  pass  down  the 
ureter.  We  certainly  meet  Avith  patients  complaining  of  much  pain  in 
the  back,  passing  bloody  urine,  containing  a  large  quantity  of  uric  acid 
crystals,  and  a  little  jius,  who  are  curable  with  large  doses  of  citrate  of 
potash.  A  solution  of  borax  is  very  usefid  as  an  injection  for  leucorrhcea. 
It  probably  acts  in  part  on  account  of  its  alkalinity. 

A  tablespoonful  of  common  washing  soda,  added  to  half  a  gallon  of 
warm  water,  is  useful  in  the  treatment  of  tenderness  of  the  soles.  The 
feet  should  be  immersed  for  half  an  hour  twice  a  week  or  oftener. 

I  may  here  introduce  a  summary  of  some  interesting  experiments  made 
by  Dr.  Paul  Guttmann,  and  some  by  myself,  which  confirm  many  of  the 
conclusions  of  Claude  Bernard  and  others,  on  the  action  of  potash  and 
soda  salts.  The  results  are  singular,  and  scarcely  in  acccordance  with 
medical  experience  of  the  action  of  these  substances  on  the  human  body. 

Potash  Salts  are  all  far  more  poisonous  than  soda  salts. 

Potash  salts  are  all  eciually  poisonous  and  equally  fatal  in  the  same  space  of  time, 
if  administered  in  the  same  way. 

Chloride  of  potassium,  carbonate  of  potash,  and  nitrate  of  potash,  in  identical  doses, 
are  equallj'  powerful  to  destroy  life,  and  in  the  same  period  of  time,  even  when  either 
salt,  previous  to  injection,  is  mixed  with  a  solution  of  albumen. 

The  acid  of  the  salt  ])lays  no  part  in  the  fatal  result. 

In  poisonous  doses  great  muscular  weakness  sets  in,  first  appearing  in  the  hinder 
extremities;  while,  in  warm-blooded  animals,  dyspnwa  and  convulsions  take  place. 
Large  doses  lessen  the  frequency  and  force  of  the  heart's  beats,  and  sometimes  make 
them  irregular.  This  holds  good  with  all  potash  salts.  Large  doses  at  once  arrest 
the  action  of  the  heart,  which  always  ceases  to  act  in  the  diastole. 

Traube  asserts  that  the  action  on  the  heart  is  affected  through  the  vagi  nerves. 
Guttmann  considers  this  view  erroneous,  as,  after  the  vagi  were  both  divided,  and  the 
medulla  removed,  the  potash  salts  still  affected  the  heart  as  before,  and  even  when  the 
vagi  was  i)aralyzed  by  woorali,  the  potash  salts  still  acted  as  usual  on  this  organ. 
Whether  their  effect  on  the  heart  is  owing  to  their  action  on  the  heart's  substance,  or 
on  its  ganglia,  Guttmann  cannot  say.  He  states  that  these  salts  lower  the  temperature 
of  the  body;  but  certainly  to  a  very  insignificant  extent. 

Soda  Salts,  in  twice  or  three  times  the  quantity  which  proves  fatal  in  the  case  of 
the  potash  salt,  produces  no  effect  on  the  sj'stem  except  a  passing  weakness. 

Even  in  larger  doses,  soda  salts  exert  no  action  on  the  heart,  cause  no  diminution 
in  the  temperature,  and  produce  no  apparent  effect  on  the  cord,  brain,  nerves,  or 
muscles. 

The  heart  of  a  frog  suspended  in  a  solution  of  potash  quickly  ceases  to  contract, 
whilst  it  takes  a  much  longer  time  to  produce  a  like  effect  in  a  solution  of  soda  of 
similar  strength. 

Many  soda  salts  produce  an  opacity  of  the  lens  in  frogs,  but  this  does  not  occur 
with  sulphate  of  soda.  Guttmann  shows  that  the  opacity  is  not  due  to  mere  abstraction 
of  water  from  the  lens;  though  this  condition  is  removed  by  immersing  the  opaque 
lens  in  water.     This  opacity  does  not  take  place  in  mammiferous  animals. 

Some  experiments  on  chloride,  bromide,  and  iodide  of  potassium  I  made,  in  com- 
pany \\ith  Mr.  E.  ]Morshead,  lead  us  to  conclusions  similar  to  those  arrived  at  by  Gutt- 
mann. We  find  that  these  three  salts  produce  the  same  symptoms  in  the  same  order, 
and  with  an  intensity  proportioned  to  the  amount  of  potash  they  contain. 

In  conjunction  with  Dr.  Murrell,  I  have  recently  made  some  further  investigations 
concerning  the  action  of  chloride  of  potassium  {Journal  of  Physiology ,  vol.  i..  No.  1). 

This  salt,  we  find,  is  a  protoplasmic  poison.     It  poisons  all  nitrogenous  tissues  and 

destroys  their  functions.     A  subcutaneous  injection  speedily  affects  the  brain  and  cord, 

causing  complete  general  paraljsis,  and  in  a  few  hours  the  motor  nerves,  when  directly 

stimulated  by  the  interrupted  current,  cease  to  conduct  impressions.     A  little  later  still 

10 


146  AMMONIA. 

the  muscles  will  not  contract  to  electric  stimulation.  Now  this  paralysis  of  all  the  tis- 
sues is  due  to  the  dircft  action  of  tlic  jiotash,  and  not  to  the  arrest  of  the  circulation, 
since  the  i)aralvsis  of  the  nerves  and  nnisclcs  occurs  nnieh  earher  after  poisoning  with 
chloride  of  iiotassiuni  than  after  mere  mechanical  arrest  of  the  circuhvtion. 

We  conclude  also  that  tlie  chloride  acts  by  an  equal  affinity  for  all  protoplasm, 
and  destroj's  the  tissues  in  the  order  of  their  vital  endowments.  Potash  salts  are  de- 
pressors and  paralj'zers  of  the  heaiH.  How  do  the}'  paralyze  the  heart  ?  In  the  same 
manner,  we  conclude,  as  they  paralyze  the  other  structures,  by  an  atlinity  for  all  the 
nitrogenous  tissues.  The  uiore  highly  endowed  nervous  ganglia  are  the  tirst  to  suffer, 
hence  small  doses  will  arrest  the  heart,  whilst  the  muscular  tis.sue  will  still  respond  to 
galvanic  stimulation;  but,  if  into  the  jugular  vein  a  large  quantity  of  potash  .salt  is  at 
once  introduced,  it  will  destroy  not  only  the  functioris  of  the  nervous  structures, 
but  also  muscular  contractility.  Thus  Guttmanu  found  that  the  injection  of  small 
doses  into  the  jugular  vein  of  warm-blooded  animals  paralyzes  through  the  nervous 
system;  whilst  Traube  found  that  the  injection  of  a  large  dose  paralyzes  also  the  mus- 
cular tissue,  so  that  it  failed  to  contract  on  the  application  of  galvanism.  These  ex- 
periments strongly  support  the  views  we  have  advanced. 

If  it  seems  strange  that  chloride  of  potassium  produces  such  profound  effects  on 
frogs,  whilst  it  appears  so  harmless  a  drug  to  man,  we  need  merely  i)oint  out  that  our 
frogs  were  given  a  quantity  proportionate  to  from  3  to  9  ozs.  for  a  man  weighing  150 
pounds,  and  so  large  a  dose  thrown  at  once  into  his  circulation  would  doubtless  pro- 
foundly affect  the  chemical  condition  of  the  blood,  and  the  functional  acti\ity  of  the 
organs. 

As  arrest  of  the  circulation  is  itself  a  paralyzing  influence,  we  conclude  that  arrest 
of  the  circulation  caused  by  the  chloride  of  potassium  must,  in  some  degree,  assist  in 
direct  action  on  the  tissues. 

In  the  chapter  on  Bromide  of  Potassium,  we  have  shown  that  it  produces  the  same 
symptoms,  in  the  same  order,  as  other  potash  salts,  and  that  the  more  or  less  rapid 
induction  of  these  symptoms  depends  on  the  amount  of  potash  the  salt  contains. 
Bromide  of  potassium,  like  the  chloride,  paralyzes  not  only  the  central  nervous  system, 
but  likewise  the  nerves,  muscles,  and  heart,  the  central  nervous  system  being  affected 
sooner  than  the  nerves,  and  the  nerves  sooner  than  the  muscles,  and  therefore  we  con- 
clude that  these  effects  of  bromide  of  potassium,  which  it  possesses  in  common  with  all 
potash  salts,  are  due  solely  to  the  potash,  the  bromide  playing  no  part  in  their  produc- 
tion. 

Potash  salts  differ  from  soda  salts,  not  merely  in  degree,  but  in  kind.  We  find  in 
the  vegetable  kingdom  that  soda  salts  will  not  replace  potash  salts.  In  animals  we  find 
potash  salts  predominating  in  the  formed;  soda  salts  in  the  unformed  constituents  of 
the  body.  A  potash  salt  is  neces.sary  for  the  due  dilatation  of  the  heart  after  a  contrac- 
tion, and  for  this  purpose  soda  salts  cannot  in  any  degree  take  the  place  of  potash  salts. 
Potash  salts  lessen  muscular  excitability;  prolong  the  period  of  diminished  excita- 
bility, and  retard  reparation  following  a  contraction,  in  these  respects  strongly  contrast- 
ing Vith  soda  salts.  These  physiological  differences  imply  therapeutic  differences, 
and  hence  one  base  cannot  be  given  in  place  of  the  other. 


AMMONIA,    CARBONATE    OF    AMMONIA,    SPIRITS    OF    AM- 
MONIA. 

These  preparations  have  many  properties  in  common  with  the  alkaline 
potash  and  soda  group.  They  possess  a  strong  alkaline  reaction,  are  freely 
soluble  in  water,  have  a  high  diffusion-power,  and  dissolve  the  animal 
textures.  They  differ  from  the  potash  and  soda  preparations  in  their 
volatility,  in  being  more  powerful  local  irritants  of  the  living  animal 
tissues,  and  exciting  very  active  inflammation. 

Their  action  on  the  skin  is,  in  many  respects,  similar  to  that  of  the 
alkaline  potash  and  soda  preparations.  "^  Owing  to  the  water  in  its  com- 
position, liquid  ammonia  manifests  but  little  attraction  for  that  of  the 
tissues;  and  since  its  solvent  action  on  the  textures  is  less  than  that  of 
the  soda  or  potash  salts,  its  destructive  powers  are  much  less  rapid  and 
extensive.     Owing,  however,  to  its  high  diffusion-power,  it  readily  pene- 


AMMONIA.  147 

ti-ates  the  cuticular  covering  of  the  body,  and  excites  a  degree  of  active 
inflammation  sufficient  to  destroy  the  tissues,  and  so  produce,  first  a 
slough,  then  an  ulcer.  The  preparations  of  the  members  of  this  group 
are  never  purposely  employed  to  produce  formidable  destructive  changes 
in  the  tissues,  but  are  used  in  the  form  of  liniment,  or  the  solution  of 
ammonia  itself,  as  vesicants  and  rubefacients. 

Ammonia  solution  may  be  emjDloyed  to  produce  very  speed}'  vesica- 
tion. A  few  pieces  of  lint  should  be  cut  a  little  larger  than  the  required 
blister,  and  on  the  lint  should  be  poured  ten  or  twenty  drops  of  the  strong 
solution  of  ammonia;  the  pledget  must  be  applied  at  once  to  the  skin, 
and  covered  with  a  good-sized  watch-glass.  Heat,  with  some  smarting  and 
tingling,  is  soon  felt,  and  in  a  short  time  a  rim  of  redness  appears  around 
the  glass,  denoting  that  the  application  has  done  its  work;  then  a  poultice 
promotes  the  vesication,  and  eases  the  burning  pain.  In  this  way,  a 
blister  may  be  produced  sometimes  in  ten  minutes,  though  it  ma}'  take 
half  an  hour;  so  great  is  the  difference  in  the  vesicating  action  of  ammo- 
nia, that  with  some  a  blister  does  not  form  at  all.  Hence,  it  must  be  con- 
sidered a  very  uncertain  vesicant. 

As  a  rubefacient,  or  "counter-irritant,"  it  is  more  useful;  but  it  is  in 
no  respect  superior  to  a  mustard  poultice,  the  materials  for  which  are 
always  at  hand.  The  liniment  of  ammonia,  if  merely  rubbed  or  dabbed 
on  the  skin,  acts  very  imperfectly  as  a  counter-irritant.  It  must  be  ap- 
plied on  lint,  or  linen,  kept  in  contact  with  the  skin,  when  decided  rube- 
faction  takes  place  in  a  few  minutes.  As  a  counter-in-itant,  ammonia  is 
used  for  the  same  purposes  as  mustard  poultices  or  blisters.  Ammonia 
is  a  useful  stimulant  to  the  scalp  to  promote  the  growth  of  hair  thinned 
by  illness.  Wilson  uses  half  an  ounce  of  strong  liquor  ammonias  to  six 
ounces  of  honey  water,  scented  with  almond  oil  and  spirit  of  rosemary. 

Dr.  Tilt  extols  Easpail's  sedative  lotion  in  the  treatment  of  headache 
occurring  at  the  change  of  life,  or  produced  by  defective  uterine  functions. 
The  lotion,  made  by  adding  two  ounces  of  liquor  ammonias,  aiid  of  com- 
mon salt  respectively,  and  three  drachms  of  camphorated  spirits  of  wine, 
to  thirty-two  ounces  of  water,  is  applied  to  the  jDainful  part  with  a  small 
sponge,  and  is  renewed  as  often  as  may  be  required.  It  excites  a  sensa- 
tion of  burning,  and  reddens  the  scalp.  If  too  strong,  it  should  be  di- 
luted with  water.  I  have  often  found  a  similar  application  very  useful 
to  remove  the  "  heat  and  weight "  at  the  top  of  the  head,  so  frequently 
occurring  in  women  at  the  change  of  life,  or  from  uterine  derangements, 
or  generally  impaired  health. 

The  weaker  solutions  of  ammonia  are  sometimes  applied  to  the  bites 
or  stings  of  insects,  as  wasjDS,  spiders,  etc.,  to  neutralize  the  formic  acid, 
the  active  principle  of  the  poison. 

Formic  acid  is  commonly'  said  to  be  the  poisonous  principle  in  insects,  whose 
bites  or  stings  excite  pain  and  inflammation.  This,  I  thinlv,  can  hardly  be  correct. 
The  sting  or  bite  of  an  insect  afl'ects  some  persons  moie  than  others.  The  bite  of 
a  bug  or  flea  will,  in  one  person,  cause  considerable  swelling,  whilst  in  anotiier  it 
will  excite  neither  pain  nor  swelling.  Even  in  the  same  person  we  find  tliat  per- 
haps, when  young,  insect  bites  or  stings  scarcely  aft'ected  him,  whilst  later  in  life 
they  cause  much  swelling  and  pain.  Again,  a  bug-bite  will  cause  great  swelling, 
whilst  in  the  same  individual  a  gnat,  a  flea,  or  midge,  will  cause  no  inflammation. 
The  bite  of  a  midge,  too,  will  excite  considerable  swelling  with  much  itching,  last- 
ing eiglit  or  ten  dajs,  wliilst  in  the  same  person  the  bites  of  other  insects  are  quite 
innocuous.  Now  this  dirt'eren^'e  could  not  be  if  tlie  active  principle  were  always 
tlie  same.  It  is  evident,  tlierel'ore,  that  there  must  be  some  difference  in  the  nature 
of  the  poisons  secreted  by  diflerent  insects,  and  that  it  cannot  depend  on  formic 


148  AMMONIA. 

acid  ;  or  were  this  always  present  in  the  poison  of  insects,  it  must  be  mixed  with 
some  otlier  virus  differing  in  different  animals. 

Ml".  Philip  Miall  recommends  fomentations,  with  a  solution  of  twenty 
grains  of  carbonate  of  ammonia  in  a  pint  of  boiling  water,  for  tlireatened 
mammary  abscess.  When  the  breast  is  hot,  reddened,  throbbing  and 
l^ainful,  the  effect  is  very  sjDcedy,  the  swelling  often  subsiding  in  a  few 
hours.  The  fomentations  must  be  assiduously  applied  for  half-an-hour 
at  a  time,  and  repeated  every  two  or  three  hours. 

Salts  of  ammonia,  applied  to  the  nose,  and  breathed  into  the  air-pas- 
sages, are  commonly  used  in  fainting,  and  in  poisoning  by  narcotics. 
Stimulating  the  mucous  membrane,  it  excites  the  vasomotor  centre, 
heightens  the  blood-pressure  and  averts  syncoj^e.  Thej'  are  also  used 
in  the  early  stages  of  cold  in  the  head,  and  as  derivatives,  to  remove  pain 
and  inflammation  of  the  nose  and  frontal  bones.  Ammonia  inhalations 
have  been  recommended  in  chronic  bronchitis  to  ease,  and  probably  to 
lessen,  the  over-abundant  expectoration. 

Ammonia  in  the  stomach  acts  much  in  the  manner  as  it  acts  on  the 
skin.  It  neutralizes  the  acid  it  encounters,  and  is  therefore  an  antacid; 
at  the  same  time,  if  completely  neutralized,  it  acts  as  an  excitant,  or 
even  irritant  of  the  mucous  membrane. 

Soon  after  the  administration  of  ammonia,  a  sensation  of  warmth  at 
the  pit  of  the  stomach  sets  in,  which  quickly  spreads  to  the  rest  of  the 
body.  When  the  functions  of  the  stomach  and  upper  part  of  the  intes- 
tines are  depressed  it  may  be  used  as  an  excitant.  It  often  obviates  spasm 
of  the  intestinal  canal,  and  braces  up  the  relaxed  mucous  membrane. 
Ammonia  compounds  of  this  group  are  therefore  among  the  best  antispas- 
modics. They  are  useful  remedies  for  children,  especially  for  infants, 
who  are  frequently  tormented  by  colic  or  flatulent  distention  of  the  intes- 
tines brought  on  by  bad  feeding. 

These  jireparations  may  be  profitably  employed  in  the  after  stages  of 
diarrho-a,  after  the  removal  of  the  irritating  excitant  cause,  when  the 
mucous  membrane  continues  to  pour  out  a  watery  secretion,  which  per- 
petuates the  diarrha;'a. 

The  alkaline  preparations  of  ammonia  are  employed  -in  flatulent  dis- 
tention of  the  stomach  and  intestines,  Avitli  the  view  of  absorbing  the 
excess  of  gas,  generally  consisting  of  carbonic  acid.  In  such  affections 
these  remedies  no  doubt  are  often  temporarily  useful  as  palliatives.  They 
excite  the  muscular  coat  of  the  intestine  to  contract,  and  so  promote  the 
expulsion  of  the  distending  gases. 

In  full  doses,  these  remedies  excite  an  increased  formation  of  mucus, 
and  even  vomiting;  as  emetics,  they  act  without  inducing  nausea  or  de- 
pression. They  are  seldom  employed  alone,  but  are  used  to  counteract 
the  depressing  effects  of  other  emetics. 

If  administered  too  long,  they  excite  catarrh  of  the  stomach  and  in- 
testines. 

These  substances  readily  enter  the  blood,  and  must  to  some  extent 
increase  its  alkaline  reaction;  but  owing  to  their  volatility  and  high  diffu- 
sion-power, they  are  rapidly  eliminated,  and  therefore  exert  only  a 
transient  action  on  the  blood  and  the  organs  of  the  body. 

Feltz  and  Ritter  find  that  toxic  doses  prevent  the  respiratory  functions 
of  the  blood,  and  hinder  the  oxidation  of  the  red  corpuscles,  which  will 
not  absorb  oxygen  even  when  it  is  shaken  up,  ammonia  acting  in  this 
respect  like  many  other  substances. 


AMMONIA.  149 

Large  doses  injected  into  a  vein  excite  tetanic  convulsions  of  spinal 
origin. 

In  experiments  with  the  detached  frog's  heart,  fed  with  an  artificial 
circulation.  Dr.  Sainsbury  and  I  find  that  ammonium  salts,  in  small  doses, 
increase  the  strength  of  the  ventricular  contractions,  but  larger  doses 
destroy  muscular  contractility,  spontaneous  action  continuing  till  con- 
tractility is  lost,  even  when  the  ventricle  is  strongly  stimulated.  Ammo- 
nium salts  act  nearly  as  powerfully  as  potassium  salts  on  the  cardiac 
muscular  tissues;  but  ammonium  salts  do  not  weaken  the  spontaneous 
rhythm,  and  in  this  respect  diifer  strikingly  from  potassium  salts.  A 
large  dose  of  ammonia  injected  into  the  blood  of  warm-blooded  animals 
arrests  the  heart  at  once. 

Carbonate  of  ammonium,  and,  in  a  less  degree,  citrate  and  acetate  of 
ammonium,  produce  perspiration.  A  small  dose,  one  or  two  grains  of  car- 
bonate, given  hourly,  generally  produces  jDerspiration  as  abundantly  as 
either  aconite  or  turtar-emetic.  Carbonate  of  ammonia  is  one  of  the 
most  certain  and  efficient  diaphoretics  in  febrile  diseases. 

It  has  been  maintained,  without  much  show  of  proof,  that  carbonate 
of  ammonium  is  the  poisonous  agent  in  uremia;  the  urea,  it  is  said,  de- 
composes in  the  blood,  forms  this  carbonate,  which  in  its  turn  produces 
the  serious  symptoms  constituting  ureemic  poisoning. 

Ammonia  induces  a  slight  increase  in  the  force  of  the  pulse,  some  ex- 
citement of  the  brain,  and  a  general  sensation  of  warmth.  Being  a  slight 
stimulant  of  the  heart,  ammonia  is  used  in  fainting  and  exhaustion.  It 
is  frequently  administered  as  an  antispasmodic — an  action  depending 
probably,  in  part,  on  its  power  to  strengthen  the  heart's  action,  but,  like 
all  other  antispasmodics,  its  influence  is  brief. 

Carbonate  of  ammonium  is  often  employed  as  a  stimulating  expectorant 
in  chronic  bronchitis,  when  the  expectoration  is  profuse  and  the  patient's 
strength  is  diminishing.  It  is  often  given  with  chloride  of  ammonium, 
which  probably  acts  in  a  similar  manner.  Carbonate  of  ammonium  is 
frequently  of  signal  service  in  severe  bronchitis,  or  broncho-pneumonia 
of  children,  especially  when  they  are  prostrate  and  livid  from  obstructed 
breathing. 

Carbonate  of  ammonium  is  largely  used  in  typhoid  conditions  due  to 
erysipelas,  or  in  the  other  acute  specific  fevers,  pyaemia,  etc. 

Carbonate  of  ammonium,  in  three  to  five  grain  doses,  administered 
uncombined  with  any  other  drug,  hourly,  or  even  two  or  three  hours, 
according  to  the  severity  of  the  case,  has  been  much  lauded  in  scarlet 
fever.  It  was  largely  used  by  the  late  Dr.  Peart,  who  "  did  not  lose  one 
patient  out  of  nearly  three  hundred."  The  late  Mr.  Wilkinson  also  em- 
ployed it  largely  with  equal  success;  and  recently  Mr.  Charles  Witt  has 
written  a  pamphlet  extolling  its  virtues.  It  is  said  to  be  useful  in  all 
forms  of  scarlet  fever,  especially  when  given  early.  The  immediate  effects 
are  stated  to  be  diminution  of  heat,  fever  and  delirium,  and  a  disposition 
to  sleep.  Mr.  Wilkinson  says  it  is  equally  useful  in  measles,  and  that 
the  ammonia  treatment  leaves  no  secondary  evils.  I  have  used  this  treat- 
ment largely  in  measles,  apparently  with  considerable  benefit.  Carbonate 
of  ammonium  induces  free  perspiration,  and  appears  to  develop  the  rash 
and  cause  the  disease  to  run  a  benign  course.  Mr.  Charles  Witt  says, 
care  must  be  taken  that  no  acid  drinks  nor  acid  fruits  of  any  kind  are 
permitted,  or  the  ammonia,  becoming  neutralized,  loses  its  efficacy.  Solu- 
tion of  acetate  of  ammonium,  and  citrate  of  ammonium,  are  useful  dia- 
phoretics, and  are  largely  employed  in  fevers.     It  is  especially  useful  in 


150  mag]s:esia. 

the  milder  forms,  as  in  common  catarrh.  A  full  dose  of  acetate  of  am- 
monia, or  Mindererus's  spirits,  will  often  speedily  steady  and  sober  a 
drunkard.  The  supposed  effect  of  ammonia  in  preventing  iodism  is 
noticed  in  another  place. 

Ammonium  salts  are  powerful  antiseptics,  especially  the  liquor  and 
carbonate,  and  possibly  they  may  act  beneficially  in  the  acute  specific 
fevers,  in  virtue  of  this  property. 

Owing  to  its  high  diffusion-power,  ammonia  escapes  very  readily  from 
the  body  in  various  ways,  a  portion  passing  with  the  breath,  some  proba- 
blv  with  the  sweat,  and  much  with  the  urine. 

The  taste  of  carbonate  of  ammonium  is  much  masked  by  administer- 
ing it  in  milk. 


MAGNESIA,  LIGHT  MAG^^SIA,  CARBONATE  OF  MAGNESIA, 
LIGHT  CAEBOXATE  OF  MAGNESIA,  SOLUTION  OF  CAR- 
BONATE OF  MAGNESIA. 

These  substances,  having  an  alkaline  reaction,  might  be  placed  in  the 
group  of  potash  and  soda  alkalies,  but  the  effects  of  the  magnesia  group 
on  the  body  are,  in  many  respects,  very  different  from  those  of  the  potash 
and  soda  group.  We  have  elsewhere  treated  of  the  properties  pertaining 
alike  to  all  alkaline  substances,  including,  of  course,  the  members  of  this 
group.     (See  Potash  group.) 

Some  of  the  oxide  of  magnesia  combines  with  the  acids  of  the  gastric 
juice,  and  becomes  soluble;  the  remainder,  being  unaffected,  is  left  in- 
soluble. Part  of  the  carbonate,  decomposed  by  the  acids  of  the  stomach, 
sets  free  its  carbonic  acid. 

These  substances  act  as  antacids  and  as  antidotes,  in  poisoning  by  the 
strong  acids  and  by  some  metallic  salts.  In  some  cases,  they  are  prefera- 
ble as  antacids  to  bicarbonate  of  soda  or  lime.  The  advantages  of  the 
members  of  this  group  are: — (1)  their  large  saturating  capacity  for  acid; 
(2)  their  purgative  property;  (3)  their  harmlessness,  on  account  of  their 
insolubility,  when  given  in  excess. 

Their  disadvantage  consists  in  their  great  bulk.  The  oxide  or  carbon- 
ate of  magnesia  is  generally  used  as  an  antacid,  but  the  oxide  is  prefera- 
ble, as  the  carbonate,  by  giving  off  much  gas,  may  produce  disagreeable 
distention  of  the  stomach.  It  must  not  be  forgotten  that  tliev  are  merely 
temporizing  remedies,  and  that  acids  are  far  better  correctives  of  acidity 
of  the  stomach.     (See  Acids.) 

The  oxide  of  magnesia  is  a  convenient  antidote  to  the  strong  mineral 
or  vegetable  acids.  It  neutralizes  them,  and  piotects  the  delicate  struc- 
tures of  the  stomach  from  their  corroding  action;  and  it  precipitates  many 
metals  from  their  acids,  rendering  them  less  soluble,  and,  therefore,  less 
poisonous.  The  magnesias  form  an  insoluble  compound  with  arsenic,  and 
thus  take  rank  among  the  antidotes  of  this  poison. 

The  magnesian  salts  combine  in  part  with  the  acids  of  the  gastric  juice. 
The  oxide  and  carbonate,  on  account  of  their  insolubility,  cannot  pass  into 
the  blood,  nor  does  the  chloride  pass  in  any  amount  because  of  its  low 
diffusion-power.     Hence,  almost  all  the  magnesia  passes  into  the  intestines. 

In  the  intestines,  the  salts  of  magnesia  undergo  changes  according  to 


LIME.  151 

their  composition.  The  chloride,  probably,  is  decomposed  by  the  bile, 
and  the  oxide  precipitated,  part  of  which  combines  with  the  biliary  acids. 
The  oxide  is  converted  first  into  the  carbonate,  then  into  the  bicarbonate 
by  the  carbonic  acid  of  the  intestines,  and  so  made  soluble,  and  capable 
of  acting  as  a  purgative.  The  carbonate  is  changed  in  a  similar  manner 
into  the  bicarbonate,  and  likewise  becomes  a  purgative.  Thus  they  act  as 
purgatives  only  after  conversion  into  bicarbonates,  in  which  form  they 
possess  most  of  the  properties  of  the  groiip  which  includes  sulphate  of 
magnesia,  etc.  Like  the  members  of  this  group,  the  bicarbonate  has  a 
very  low  diffusion-power,  and,  like  them,  it  is  purgative;  its  action  in 
this  respect  being  very  mild,  it  is  termed  a  laxative.  Their  mild  action, 
freedom  from  taste,  and  antacid  property,  fit  these  substances  admirably 
for  children.  They  are  generally  combined  with  a  little  rhubarb.  If 
unduly  employed  they  occasionally  accumulate,  and  form  concretions  of 
ammonio-magnesian  phosphates  in  the  intestines. 

Bicarbonate  of  magnesia,  fluid  magnesia  as  it  is  termed,  is  a  useful 
and  mild  aperient. 

Magnesia  has  been  lauded  in  sympathetic  vomiting,  as  that  of  preg- 
nancy, when  it  is  to  be  presumed  the  vomiting  depends  on  excessive  secre- 
tion of  acid  from  the  stomach;  but  its  eft'ects  are  very  transient.  Should 
it  fail,  recourse  may  be  had  to  oxalate  of  cerium  (one  grain  every  three 
hours),  ipecacuanha,  quinine,  acids,  etc.     (See  Ipecacuanha.) 

The  chief  of  the  magnesia  passes  out  witii  the  faeces,  and,  for  the 
reasons  stated,  a  small  portion  only  enters  the  blood.  In  excess  of  uric 
acid,  members  of  this  group  prove  useful  by  saturating  much  of  the  acid 
in  the  stomach,  and  carrying  it  out  of  the  body. 


LIME,  CAUSTIC  LIME,  LIME-WATER,  LINIMENT  OF  LIME, 
SACCHARATED  SOLUTION  OF  LIME,  CARBONATE  OF 
LIME. 

This  group  contains  highly  valuable  medicinal  substances,  which 
might  with  advantage  be  more  extensively  used. 

Lime  is  a  necessary  constituent  of  the  hard  and  soft  tissues  of  the 
body,  of  bone,  and  the  parts  more  vitally  endowed,  as  the  nerves  and 
muscles;  wherever  there  is  active  growth,  whether  natural  or  unnatural, 
lime  salts  are  found  in  excess,  probably  as  phosphate,  being  in  all  likeli- 
hood the  form  of  lime  required  by  the  body  for  the  performance  of  many 
of  its  functions.  In  practice,  however,  we  find  the  other  salts  of  lime  of 
equal  service  in  almost  precisely  the  same  morbid  state  in  which  the  phos- 
phate is  so  valuable,  and  it  seems  feasible  that  a  portion  of  the  lime  salts 
becomes  united  in  the  body  with  phosphoric  acid. 

The  importance  of  lime  is  well  shown  in  its  influence  on  a  cardiac  con- 
traction. Without  lime  it  is  probable  that  no  contraction  could  occur. 
If  too  little  lime  is  present  then  the  contraction  is  weak,  but  if  a  full 
physiological  quantity  is  present  in  the  fluid  circulating  through  the  heart 
the  contraction  becomes  complete. 

Their  diffusion-power  being  very  low,  and  having  little  aflfinity  for 
animal  structures,   when  applied  to  the  skin  they  produce  very  little 


152  LIME. 

change.  But  caustic  lime,  having  a  strong  attraction  for  water,  will  with- 
draw it  from  tlie  dermis  when  deprived  of  its  cuticle,  and  to  some  extent 
effect  the  destruction  of  the  tissues.  Yet,  as  its  diffusion-power  is  slight, 
it  fails  to  penetrate  the  tissues,  and  its  action  is  superficial.  Caustic  lime 
is  not  often  used  as  an  escharotic.  Mixed  with  caustic  potash,  it  forms  a 
compound  less  deliquescent,  far  more  manageable,  and  safer  than  simple 
caustic  potash,  especially  in  affections  of  the  neck  of  the  uterus,  as  first 
pointed  out  by  Dr.  Henry  Bennet. 

Applied  to  broken  skin  and  to  sores,  the  carbonate  and  lime-water  are 
slightly  astringent;  hence  lime  is  sometimes  used  to  check  the  discharge 
from  sores  and  skin  eruptions. 

Lime-water  and  oil  in  equal  quantities,  or  in  the  proportion  of  four  of 
lime-water  to  one  of  oil,  enjoys  a  high  reputation  in  the  treatment  of 
burns. 

Lime-water  is  of  service  as  a  lotion  to  cracked  nipjiles. ' 

Lime-water  is  sometimes  employed  to  check  the  abundant  discharge 
of  certain  skin  diseases,  as  eczema,  and  likewise  as  a  sedative  to  ease  the 
smarting  and  tingling.  When  the  inflammation  of  eczema  has  been  sub- 
dued, the  discharge  being  great,  lime-water  and  glycerine  form  a  useful 
and  comforting  application. 

Carbonate  of  lime  is  sometimes  used  as  a  dusting  powder  in  eczema  or 
intertrigo,  to  absorb. the  abundant  secretion,  to  prevent  discharges  from 
irritating  the  already  inflamed  skin,  and  to  protect  the  skin  from  the  air. 
In  common  with  other  dry  powders,  carbonate  of  lime  is  inferior  to  some 
simple  bland,  or  slightly  stimulating  greasy  application.  Certain  cases, 
however,  are  certainly  more  benefited  by  dry  powders,  as  oxide  of  zinc, 
bismuth,  and  carbonate  of  lime,  than  by  ointments. 

As  we  have  said,  carbonate  of  lime  is  used  for  intertrigo  of  the  buttocks 
and  perinajum  of  young  children,  and  to  protect  the  skin  from  the  irrita- 
tion of  the  urine  and  of  the  air.  Napkins  soaked  in  urine  being  very 
generally  the  cause  of  this  eruption,  it  is  obvious  that  greasy  applications 
afford  a  more  efficient  protection,  since  the  powder  readily  absorbs  dis- 
charges, becomes  itself  irritating  to  the  skin,  cakes  and  cracks,  leaving 
parts  of  the  surface  exposed.  The  best  treatment  indeed  consists  in  fre- 
quent ablutions  with  soap  and  water,  and  anointing  with  greasy  applica- 
tions, as  boracic-acid  ointment. 

Lime-water,  on  account  of  its  astringent  quality,  is  used  as  a  wash  in 
discharges  from  the  ears  and  vulva,  and  is  of  most  service  when  some 
active  inflammation  is  still  present.  In  the  chronic  stages  of  ear  disease 
it  is  far  inferior  to  the  glycerine  of  tannic  acid  and  other  astringents. 

Dr.  Joseph  Bell  recommends  lime-liniment  with  cotton-wool  to  prevent 
small-pox  pitting.  Cotton- wool  cut  in  proper  shapes  is  dipped  into  the 
liniment,  and  applied  so  as  carefully  to  cover  the  face  and  neck,  leaving 
apertures  for  the  eyes,  nose,  and  mouth.  Xo  crevice  must  be  allowed, 
and  a  large  handkerchief  must  be  tied  over  all,  and  the  dressing  allowed 
to  remain  on  until  convalescence. 

iiime- water,  probably  owing  to  its  alkalinity,  is  often  iiseful  as  an  in- 
jection in  leucorrhasa. 

'  To  prevent  cracked  nipples  is  far  better  and  much  easier  than  to  cure  them.  Im- 
mediately the  child  is  removed  from  the  breast  the  nipple  should  be  carefully  Avashed 
and  driexi.  The  nipples  may  be  hardened  by  washing  Ihem  some  short  time  before 
delivery,  and  after  each  suckling,  with  a  little  brandy  and  water.  A  zinc  sliield  worn 
constantly  over  the  nipple  is  both  healing  and  protective. 


LIME.  153 

Chalk  makes  a  good  tooth-powder,  and  is  safer  than  powder  with  hard 
and  angular  particles,  which  wear  away  the  enamel  and  lay  bare  the 
dentine. 

Lime-water  is  occasionally  used  to  lessen  the  discharge,  and  to  pro- 
mote the  healing  of  inflammatory  and  ulcerative  diseases  of  the  mouth. 

Solutions  of  lime,  as  lime-water,  will  dissolve  false  membranes,  as 
diphtheritic  membranes,  and  either  lime-water  itself,  or  the  following 
formula: — Calcis  half  an  ounce,  glycerine  two  ounces,  water  eight 
ounces.  It  should  be  used  as  a  spray  frequently.  Though  strongly 
recommended  by  several  excellent  authorities,  still  this  treatment  of  diph- 
theria is  of  doubtful  efficacy.     It  is  also  recommended  in  plastic  bronchitis. 

Lime  preparations  neutralize  the  acid  in  the  stomach,  but  other  reme- 
dies are  mostly  preferred.     Salts  of  lime  are  useful  in  oxalic  acid  poisoning. 

It  is  not  easy  to  indicate  precisely  the  therapeutic  value  of  lime-water 
in  vomiting,  but  in  some  forms  of  it  few  remedies  are  more  useful.  It  is 
generally  serviceable  iu  chronic  vomiting;  thus  it  often  arrests  the  vomit- 
ing from  chronic  ulcers  of  the  stomach.  It  should  be  mixed  with  milk, 
either  in  ecpial  parts  or  in  the  proportion  of  one  of  lime-water  to  four  of 
milk;  and  if  the  vomiting  is  incessant  the  patient  should  be  fed  only  on 
this,  in  frequent  small  quantities  of  a  tea  or  tablespoonful.  Young  chil- 
dren often  eject  much  of  their  milk  in  lumpy  masses;  some  passing  into 
the  intestines,  and  escaping  with  the  motion,  cause  in  their  transit  much 
wind  and  severe  colic.  Cows'  milk  is  apt  to  induce  this  condition,  as 
gastric  juice  coagulates  it  in  lumps,  while  it  generally  coagulates  human 
milk  in  fine  flakes.  Lime-water,  by  j)reventing  this  lumpy  coagulation, 
checks  this  kind  of  vomiting  generally  at  once,  or,  should  it  continue,  the 
rejected  milk  is  no  longer  curdled.  In  case  of  constipation,  bicarbonate 
of  soda  should  be  substituted  for  lime-water.  One-eighth  of  lime-water  is 
generally  suffiicient,  but  this  failing,  a  larger  quantity,  even  equal  parts  of 
each  should  be  tried.  Half  a  drachm  to  a  drachm  of  bicarbonate  of  soda 
should  be  added  to  a  pint  of  milk.  These  remedies  both  sometimes  fail, 
and  it  may  be  necessary  for  a  time  to  withhold  milk,  and  to  feed  the  child 
on  sopped  bread,  water  gruel,  and  chicken  broth,  or  veal  broth. 

This  vomiting  occurs  in  the  early  months  of  life,  sometimes  even 
during  suckling.  If  the  child  is  brought  up  "  by  hand  "  the  milk  should 
be  sufficiently  diluted,  and  during  the  first  month  witli  at  least  an  equal 
quantity  of  water;  indeed,  some  authorities  advise  two  parts  of  water  to 
one  of  milk,  the  relative  quantity  of  milk  increasing  as  the  child  grows 
older.  A  child  a  month  old  may  take  a  pint  to  a  pint  and  a  half.  Dr. 
Meigs,  of  Philadelphia,  recommends  an  excellent  food  for  healthy  chil- 
dren, and  especially  for  those  suffering  from  the  kind  of  vomiting  under 
consideration: — Soak  a  scruple  of  gelatine  in  a  little  cold  water  for  a  short 
time,  and  boil  it  in  half  a  pint  of  water  till  it  is  dissolved,  that  is  about 
ten  or  fifteen  minutes.  Just  before  finishing  the  boiling,  add  milk  with 
some  arrowroot  made  into  paste  with  cold  water,  and  afterwards  some 
cream.  The  proportion  of  the  milk,  cream,  and  arrowroot  depends  on 
the  age  of  the  child.  For  an  infant  less  than  a  month  old  he  advises  three 
to  four  ounces  of  milk,  a  teaspoonful  of  arrowroot,  and  half  an  ounce  to 
an  ounce  of  cream  to  half  a  pint  of  gelatine- water;  for  older  children  the 
milk  may  be  increased  to  half  or  two-thirds.  The  gelatine  and  arrowroot 
prevent  the  lumpy  coagulation  of  the  milk,  while  the  small  quantity  of 
arrowroot  will  not  disorder  the  stomach.  If  even  this  food  is  rejected, 
then  dilute  the  milk  with  three  or  even  four  parts  of  a  very  thin  decoc- 


154  LIME. 

tion  of  arrowroot,  or  try  merely  cream  and  Avater,  one  part  of  cream  to 
three  or  four  of  water.  This  food  consisting  of  milk,  cream,  arrowroot, 
and  gelatine-water  is  very  useful  in  diarrh(ea. 

Again,  in  young  children  suffering  from  chronic  vomiting  and  diar- 
rhoea, and  consequent  wasting,  lime-water  is  often  of  great  benefit,  im- 
proving digestion,  and  apparently  assimilation,  and  obviating  that  highly- 
irritating  state  of  the  urine  which  so  commonly  occasions  intertrigo. 

Solutions  of  these  salts  pass  but  slowly  into  the  blood,  on  account  of 
their  low  diffusion-power,  hence  the  greater  part  pass  through  the  intes- 
tines, and  are  ultimately  voided  with  tlie  faeces. 

These  substances  neutralize  any  acid  present  in  the  intestines,  and 
check  the  secretion  from  the  mucous  membrane;  and,  sometimes  by  one 
means  and  sometimes  by  both,  act  efficaciously  in  diarrhoea.  Carbonate 
of  lime,  and  in  a  less  degree  lime-water,  deservedly  hold  a  high  place 
among  remedies  for  diarrhoea  in  the  latter  stages,  Avhen  the  irritant  is  got 
rid  of.  Common  chalk  mixture  is  useful  in  diarrhoea  depending  on  more 
serious  causes,  as  ulceration  in  phthisis  or  typhoid  fever;  but  in  these 
graver  cases  other  remedies  are  to  be  preferred. 

It  has  been  said  that  the  saccharated  solution  of  lime  does  not  confine 
the  boAvels,  but  on  the  contrary  relieves  constipation.  It  should  not  be 
taken  on  an  empty  stomach,  lest  it  excite  nausea. 

Lime-Avater  is  a  useful  injection  to  destroy  the  thread- Avorms  which 
infest  the  rectum.     It  has  been  also  used  as  an  injection  in  gleet. 

From  their  Ioav  diffusion-power,  a  small  quantity  only  of  these  sub- 
stances passes  into  the  blood;  so  small,  probably,  that  it  may  well  be 
doubted  if  they  can  in  any  way  influence  the  organs  remote  from  the  in- 
testines. But  experience  shows  that  lime-AA'ater  or  carbonate  of  lime  is  a 
valuable  remed}"  in  deficient  nutrition,  and  in  conA'alescence  from  serious 
disease,  its  good  effects  being  most  marked  in  children,  in  most  stages  of 
rickets,  mal-nutrition,  etc. 

In  some  instances  these  good  results  are  traceable  to  the  action  of  the 
lime  salts  on  the  mucous  membrane  of  the  intestines.  The  action  of 
these  salts,  however,  being  A'ery  similar,  although  inferior,  to  that  of 
phosphate  of  lime,  we  refer  our  readers  to  the  section  Avhicli  treats  of  this 
salt.  One  point  may  be  noticed  here,  confirmed  by  both  theory  and  ex- 
perience, that  small  Avill  do  as  much  good  as  large  doses,  since  but  lit- 
tle lime  passes  into  the  blood. 

In  scrofula  with  glandular  enlargements  of  the  neck,  in  cases  resem- 
bling tabes  mesenterica,  and  chronic  diarrhoea  with  weak  digestion.  Dr. 
Warburton  Begbie  extols  cldoride  of  calcium  in  ten  to  tAventy  grain  doses, 
given  in  milk  after  food  and  continued  for  a  considerable  time,  its  good 
effects,  in  many  cases,  not  at  once  becomiiig  apparent.  It  is  recommended 
too  in  phthisis,  and  many  Avriters  report  very  favorably  of  this  treatment. 

Lime-Avater  is  reputed  to  be  useful  in  Avhooping-cough,  and  this  may 
well  be,  OAving  to  its  astringency;  for  in  certain  forms  of  this  disease  as- 
tringents, as  alum  and  tannin,  often  effect  a  decided  improvement. 

Transfusion  of  a  saline  fluid  has  saved  several  lives  in  danger  from 
s5mcope  of  haemorrhage.  Death  in  these  cases  is  due  to  too  small  a 
quantity  of  fluid  in  the  vessels;  so  that  the  heart  cannot  propel  enough 
fluid,  and  is  not  due  apparently  to  the  Avant  of  nutritive  fluid.  This  lack 
of  quantity  can  be  supplied  by  a  saline  fluid  (Golz,  Kronecker,  Sander); 
as  much  as  two  pints  should  be  injected.  The  injection  restores  con- 
sciousness, removes  convulsions,  the  pulse  gains  greatly  in  strength  and 


PHOSPHATE    OF    LIME.  155 

falls  in  frequency.  The  patient  at  first  complains  of  feeling  cold.  I  have 
already  drawn  attention  to  the  influence  of  lime  on  cardiac  muscular  eon- 
traction,  and  the  same  holds  good  probably  in  respect  of  other  muscle.  I 
would  suggest  then  that  the  saline  injection  should  contain  a  lime  salt, 
preferably  lime  phosphate,  which  is  quite  sufficiently  soluble  to  sustain 
the  contraction  of  cardiac  muscle. 


PHOSPHATE   OF  LIME. 

This  salt  is  of  very  great  importance  both  in  health  and  in  disease.  It 
must  be  ranked  among  the  most  valuable  and  necessary  foods,  being  proba- 
bly as  essential  to  a  proper  growth  and  nutrition  as  the  nitrogenous  and 
faitty  foods.  Observations  have  abundantly  proved  its  physiological  im- 
portance. It  gives  solidity  to  the  skeleton ;  hence  if  the  quantity  supplied 
to  the  body  is  small,  or  if  the  demand  for  it  is  greater  than  the  supply, 
these  solid  structures  suffer  and  lose  their  rigidity.  Chossat  produced 
softening  of  the  bones  of  animals  fed  on  food  free  from  lime-salts;  while, 
during  pregnancy,  much  phosphate  of  lime  being  required  for  the  ossifi- 
cation of  the  skeleton  of  the  foetus,  it  is  found  that  the  fractured  bones  of 
pregnant  women  unite  slowly  and  imperfectly.  Some  experiments  by 
Milne-Edwards  bear  practically  on  this  point,  for  he  found  that  animals' 
bones  intentionally  fractured  united  more  quickly  when  the  animals  were 
supplied  with  phosphate  of  lime. 

The  urine  of  pregnant  women  is  said  to  be  deficient  in  lime  salts,  but 
on  this  point  the  evidence  is  very  discrepant. 

The  cardinal  importance  of  this  essential  food  to  the  soft  and  growing 
tissues  is  to  promote  cell-growth  and  nutrition;  and  that  this  is  a  very 
feasible  conclusion  the  following  considerations  tend  to  show: — 

1.  The  presence  of  this  salt  throughout  the  body. 

2.  Its  presence  in  much  larger  proportion  in  the  intercellular  fluid  of 
the  body  than  in  the  blood  itself. 

3.  The  fact  that  in  herbivora  the  intercellular  fluid  is  as  rich  in  this 
salt  as  it  is  in  carnivora,  though  the  vegetable-feeders  take  so  little  of  it 
with  their  food;  hence  it  must  be  carefully  retained  in  the  intercellular 
fluid  for  some  important  purpose. 

4.  Smith's  observations  show  that  a  certain  quantity  of  phosphate  is 
required  to  supply  the  first  basis  for  the  new  tissues,  even  in  the  case  of 
those  organs  which  subsequently  exhibit  an  excess  of  carbonate  of  lime, 
as  the  shells  of  animals;  an  observation  showing  that  phosphate  of  lime  is 
necessary  to  initiate  growth,  and,  in  this  respect,  is  not  interchangeable 
with  the  carbonate. 

5.  Wherever  cell-growth  is  active,  there  is  phosphate  of  lime  in  excess 
— a  statement  holding  good  both  watli  regard  to  healthy  and  diseased 
growths;  for  this  salt  is  found  to  prevail  in  disease  associated  with  rapid 
formation. 

With  regard  to  the  second  and  third  points,  it  must^  be  borne  in  mind 
that  phosphate  of  lime  is  soluble  in  acids,  and,  as  the  intercellular  fluid 
is  acid,  we  should  expect  that  the  phosphate  would  accumulate  in  it. 

Theoretically,  it  might  be  supjjosed  that  abundant  data  exist  to  enable 
us  to  forecast  the  occasions  when  to  employ  this  salt  remedially;    it  would 


156  PHOSPHATE    OF    LLME. 

be  riglitly  assumed  that  in  defective  nutrition,  or  deficient  cell-growth, 
the  phosphate  of  lime  Avould  prove  serviceable.  Certain  hypothetical  ob- 
jections have,  indeed,  been  urged  against  the  employment  of  this  salt. 
The  fault,  it  has  been  said,  is  really  not  due  to  deficiency  of  lime,  but 
inheres  in  the  tissues,  which  fail  to  assimilate  it;  that,  in  cases  of  defec- 
tive cell-growth  and  of  mal-nutrition,  the  quantity  of  the  pliosphate  in 
the  urine  is  unusually  great;  and,  consequently,  our  elforts  should  be 
directed  to  remove  the  circumstances  which  check  assimilation,  for  it  is 
as  little  reasonable  to  treat  diabetes  with  sugar  as  a  diabetes  of  phosphate 
of  lime  with  phosphate  of  lime.  Some  truth  no  doul)t  there  is  in  these 
strictures,  and  too  much  attention  cannot  be  paid  to  the  hygienic  condi- 
tions favorable  to  assimilation — good  air,  abundant  light,  and  sufhcient 
exercise.  The  case  before  us  is  more  analogous  to  anaemia  than  to  dia- 
betes; and  we  give  iron  with  decided  benefit  in  anaemia  where  this  condi- 
tion is  due,  not  to  want  of  iron  in  the  food,  but  to  the  non-assimilation 
of  it  by  the  tissues.  The  efficacy  of  phosphates,  however,  must  be  decided 
by  experience,  and  experience  speaks  abundant!}'  in  their  favor.  Beneke, 
to  whom  on  this  subject  we  owe  much  of  our  knowledge,  both  physiologi- 
cal and  therapeutical,  has  shown  that  phosphate  of  lime  is  especially  use- 
ful in  those  "very  diseases  wherein  it  occurs  in  excess  in  the  urine,  as  hectic 
and  chronic  wasting  disease. 

Tills  salt  is  of  great  use  in  the  anremia  of  young  and  rapidly-growing 
persons,  and  women  weakened  by  rapid  child-bearing,  prolonged  suckling, 
or  excessive  menstruation.  In  checking  chronic  tubercular  and  non- 
tubercular  diarrhoea,  and  other  profuse  discharges,  as  in  leucorrhoea, 
chronic  bronchitis  and  large  abscesses,  it  is  a  valuable  remedy,  effecting 
in  these  states  both  general  and  local  improvement.  Beneke  speaks  highly 
of  its  influence  on  scrofulous"  sores.  It  is  useful  also  in  caries  of  the 
bones. 

This  salt  is  apt  to  be  deficient  in  town-dwelling  women,  who  improve 
under  its  administration;  an  increased  quantity,  too,  finds  it  way  into  the 
lime-lacking  milk  of  a  suckling  mother,  who  with  her  child  are  thus 
simultaneously  benefited. 

Persons  in  broken  health  from  prolonged  town  life  or  over-work,  or 
who  from  other  causes  are  languid,  hipped,  and  incapable  of  much  exer- 
tion, often  derive  much  benefit  from  this  medicine.  In  cases  like  this,  a 
good  formula  is  a  grain  of  phosphate  of  lime,  phosphate  of  iron,  and  car- 
bonate of  lime;  but  phosphate  of  lime  will  act  admirably  by  itself.  This 
medicine  is  useful  in  the  chronic  forms  of  phthisis  with  little  or  no  fever. 
It  should  be  taken  on  the  tongue  either  dry  or  mixed  with  a  little  milk. 

No  reasonable  doubt  can,  I  think,  be  entertained  of  tlie  efficacy  of 
phosphate  of  lime  in  many  cases  of  rickets. 

It  has  been  sought  to  establish  a  connection  in  all  cases  between  rickets 
and  a  deficient  supply  of  lime;  it  is  urged,  firstly,  that  rickets  commonly 
occur  during  the  first  dentition,  Avhen  much  lime  is  required  by  the  grow- 
ing teeth,  and,  secondly,  that  rickets  affect  the  children  of  mothers  in  just 
that  state  of  ill-health  in  which  it  has  been  established  that  the  milk  is 
deficient  in  lime.  There  may  be  much  truth  in  these  statements;  but,  as 
in  many  cases  of  rickets  an  excess  of  lime  is  found  in  the  urine,  the  disease 
in  such  cases  cannot  be  held  to  depend  on  a  deficient  supply  of  the  salt, 
but  must  be  due  to  other  circumstances,  with  which,  at  present,  we  are 
only  partially  cognizant.  In  cases  where  the  disease  is  dependent  on 
deficiency  of  phosphate  of  lime,  its  administration  is  obviously  all  that  is 
required. 


PHOSPHATE    OF    LIME.  157 

A  deficiency  of  lime  and  pliosphoric  acid  in  food  does  not  produce  in  animals  the 
changes  cliaracterislic  of  rickets,  but  the  bone  becomes  fragile. 

In  rickets,  moreover,  tliere  is  not  merely  deficient  ossification  of  the 
bones,  but  unnatural  growth  and  defective  nutrition,  both  in  the  skeleton 
and  in  the  other  textures.  The  phosphate  of  lime  appears  to  control  this 
defective  and  perverse  nittrition,  and  to  induce  healthy  growth,  so  as  not 
merely  to  favor  the  consolidation  of  the  skeleton  but  to  improve  the  con- 
dition of  the  soft  organs,  and  experience  shows  abundantly  that  many 
rickety  cases  are  benefited  more  decidedly  by  lime-salts  than  by  any  other 
single  drug. 

German  authorities,  who  have  studied  this  subject  most  attentively, 
consider  that  the  fittest  time  to  give  this  remedy  is  after  the  cessation  of 
the  active  stage  of  the  disease,  that  is,  when  the  pains  and  tenderness  of 
the  bones  have  disappeared. 

It  is  well  to  repeat  a  caution  against  the  uselessness  of  administering 
this  or  other  lime- salts  in  large  quantities,  for,  owing  to  their  very  low 
diffusion-power,  very  little  passes  into  the  blood.  A  grain,  or  two  grains, 
several  times  a  day,  is  a  sufficient  dose.  Given  in  excess,  it  hinders  diges- 
tion. 

Phosphate  of  lime  in  the  stomach  must  be  variously  affected  by  the 
free  acids,  as  lactic,  hydrochloric,  and,  in  a  lesser  degree,  acetic  acid, 
dissolve  it. 

Most  of  the  phosphate  passes  into  the  intestines,  where,  if  the  salt  is 
administered  too  long  a  time,  it  is  liable  to  form  concretions.  Being  un- 
affected by  the  pancreatic  and  biliary  secretions,  and  but  slightly  soluble 
in  the  intestinal  juice,  most  of  the  phosphate  passes  off  with  the  stools. 

Phosphate  of  lime  is  highly  recommended  in  various  forms  of  chronic 
diarrhoea,  and  especially  in  that  of  young  children,  to  wdiom  it  may  be 
given  with  carbonate  of  lime  and  lactate  of  iron.  Whether  the  beneficial 
effects  are  due  to  its  direct  action  on  the  mucous  membrane,  or  take  place 
after  absorption,  in  the  manner  previously  described,  our  present  knowl- 
edge does  not  enable  us  to  decide. 

Being  soluble  in  the  acids  of  the  gastric  juice,  and  to  some  extent  in 
solutions  of  commoi:|  salt,  its  passage  into  the  blood  takes  place  probably 
in  several  ways.  It  has,  however,  been  doubted  whether  any  portion,  if 
uncombined  with  food,  passes  into  the  blood,  since  no  augmentation  of  this 
salt  is  met  with  in  the  urine;  nay,  in  some  cases  it  seems  even  lessened. 
The  observations  on  this  point  are,  perhaps,  too  scant  to  set  the  question 
at  rest. 

Much  phosphate  is  taken,  either  in  combination  with  the  food,  or  so 
intimately  blended  with  it  that  it  is  well-nigh  impossible  to  separate  it 
from  the  tissue-forming  substances,  and  so  it  finds  ready  entrance  into  the 
blood,  with  the  digested  materials  constituting  the  chief,  and,  in  ordinary 
cases,  the  only  source  of  phosphate  of  lime  for  the  supply  of  the  system. 
That  so  alkaline  a  fluid  as  the  blood  is  capable  of  dissolving  the  phosphate 
is  explained  by  its  solubility  in  solutions  containing  free  carbonic  acid  or 
common  salt. 


158 


CHLORIDES. 


HYPOPHOSPHITE   OF    LIME,    HYPOPHOSPHITE    OF 

SODA. 

Dr.  Churchill  recommends  these  drugs  in  plitliisis,  and  his  state- 
ments regarding  their  action  have  for  the  most  part  been  upheld  b}'^  Dr. 
Thorowgood  and  some  other  observers. 

Dr.  Churchill  commences  with  a  grain  and  increases  the  dose  to  six 
or  seven  grains  a  day,  giving  it  in  the  form  of  syrup  or  pill.  Dr.  Thorow- 
good gives  a  grain  three  times  a  day  in  the  form  of  syrup.  In  too  large 
doses  it  may  produce  weakness,  sleepiness,  headache,  giddiness,  noises  in 
the  ears,  loss  of  appetite,  colic,  diarrhoea,  and  even  bleeding  from  the 
nose  and  lungs.  Dr.  Churchill  administers  these  agents  uncombined,  and 
cautions  against  giving  them  with  iron,  cod-liver  oil,  or  stimulants.  It 
is  said  that  the  hypophosphites  increase  appetite  and  digestion;  promote 
the  formation  of  the  blood;  lessen  cough  and  expectoration;  relieve  pain 
in  the  side,  and  diarrhoea;  and  often  effect  a  cure.  They  are  said  to  be 
more  useful  in  the  first  than  in  the  second  stage;  and  in  the  second  than 
in  the  third  stage;  and  when  only  one  lung  is  affected— a  statement  suffi- 
ciently obvious  and  applicable  indeed  to  every  remedy.  Thorowgood  sa3^s 
they  are  more  successful  with  young  than  with  old  people.  These  rem- 
edies are  also  recommended  in  nervous  and  general  debility;  teething; 
spermatorrhoea;  chlorosis;  and  anaemia. 


CHLOEIDE   OF   POTASSIUM,   CHLORIDE   OF   SODIUM, 
CHLORIDE  OF  AMMONIUM. 

These  substances,  having  many  chemical  and  therapeutic  qualities  in 
common,  have  been  grouped  together;  but  the  remarks  in  this  section 
refer  mainly  to  chloride  of  ammonium. 

These  salts  are  freely  soluble,  and  possess  high  diffusion-power.  The 
saltish  taste  common  to  them  all  is,  in  the  case  of  chloride  of  ammonium, 
somewhat  disagreeable,  and  constitutes  one  of  the  objections  to  its  use. 

These  chlorides  considerably  increase  the  secretion  from  the  mucous 
membrane;  and  may  indeed  even  excite  catarrh.  This  is  notably  the 
case  with  chloride  of  ammonium,  which  is  consequently  employed  chiefly 
when  it  is  proposed  to  influence  the  mucous  membrane.  How  do  these 
chlorides  promote  the  formation  of  m.ucus?  Let  us  take  the  instance  of 
common  salt.  Chloride  of  sodium  is  a  large  constituent  of  mucus,  and 
salt,  Avhen  taken  into  the  system,  probably  promotes  the  production  of 
tliose  secretions  of  Avhich  it  forms  a  large  part.  It  is,  indeed,  a  food  to 
the  mucous  membranes.  This  suggestive  hypothesis  may  possibly  apply 
in  the  case  of  other  members  of  this  group.  These  substances,  especially 
sal  ammoniac,  are  sometimes  employed  in  catarrhal  conditions  of  the 
intestines,  to  prevent  the  formation  of  that  thick  tenacious  mucus  which 
forms  a  convenient  nidus  for  the  various  worms  infesting  this  canal. 


CHLORIDES.  159 

Dr.  Eutlierford's  experiments  with  fasting  dogs  lead  liim  to  the  con- 
chision  that  common  salt  very  slightly  increases  the  secretion  of  bile. 

Owing  to  their  high  ditfusion-power,  these  salts  pass  rapidly  into  the 
blood,  and  so  travel  along  the  intestines  too  small  a  distance  to  act  as  pur- 
gatives; hence,  unless  administered  in  considerable  quantity,  they  exert 
very  little  influence  on  the  character  of  the  motions. 

Common  salt  is  used  to  produce  sickness,  or  to  promote  the  action  of 
other  emetics.  Given  in  poisoning  by  nitrate  of  silver  it  effects  a  double 
decomposition,  precipitating  the  silver  as  the  harmless  insoluble  chloride. 

Chloride  of  ammonium  is  often  given  with  considerable  success  in 
chronic  catarrhs  of  the  bronchial,  intestinal,  and  urinary  mucous  mem- 
brane. It  is  indicated  in  bronchitis  when  the  secretion  is  thick  and 
abundant,  and  it  may  be  applied  topically  to  the  morbid  mucous  mem- 
brane of  the  respiratory  tract  by  the  atomizer.  It  should  be  given  in 
twenty-grain  doses  every  three  or  four  hours,  adding  it  to  milk;  or,  still 
better,  mixing  a  drachm  of  liquid  extract  of  liquorice  with  eachdose,  freely 
diluting  it  with  water,  and  thus  concealing  its  disagreeable  taste.  It  is 
recommended  in  catarrhal  jaundice.  It  certainly  appears  to  be  very  useful 
in  the  congestive  stage  of  cirrhosis.  It  is  largely  employed  in  India  in 
hepatic  congestion  and  abscess. 

The  same  remedy  has  been  landed  for  whooping-cough.  It  is  said  to 
be  frequently  successful  in  removing  the  pain  of  facial  neuralgia  "of 
rheumatic  character."  It  should  be  given  in  half-drachm  doses,  and  if, 
says  Sir  T.  Watson,  four  doses  fail  to  give  relief,  the  drug  may  be  con- 
sidered unsuitable  for  the  case.  In  full  doses,  several  times  a  day,  I  have 
many  times  found  it  useful  in  facial  neuralgia.  Dr.  Anstie  speaks  well 
of  it  in  migraine,  clavus,  myalgia,  intercostal  and  hepatic  neuralgia,  and 
in  mild  forms  of  sciatica. 

Many  doctors  employ  this  salt  in  all  forms  of  neuralgia;  and  I  have 
heard  some  eminently  practical  men  go  so  far  as  to  assert  that  in  this 
painful  affection  they  require  no  new  remedy,  since  chloride  of  ammonium 
so  rarely  fails  in  half-drachm  doses  several  times  a  day. 

Chloride  of  ammonium  is  given  with  advantage  in  headaches  due  to 
menorrhagia,  amenorrhoea,  etc. 

Common  salt  sometimes  arrests  hgemoptysis.  Half  a  teaspoonful  should 
be  taken  undissolved,  and  be  repeated  occasionally  till  it  excites  nausea. 


1  (JO  SULPHATES. 


Group  containing  SULPHATE  OF  POTASH,  SULPHATE  OF 
SODA,  SULPHATE  OF  MAGNESLV,  PHOSPHATE  OF  SODA, 
TAKTRATE  OF  POTASH,  BITARTEATE  OF  POTASH,  TAR- 
TRATE OF   POT  AS  B  AND   SODA. 

With  the  exception  of  the  sulphate  and  bitartrate  of  potash,  these  sub- 
stances are  freely  soluble  in  water. 

The  sulphates  have  a  very  disagreeable  bitter  taste,  which  in  the  phos- 
phate of  soda  is  but  slight,  and  in  the  tartrates  is  absent. 

They  are  all  purgative,  producing  watery  evacuations. 

They  have  little  or  no  afhnity  for  animal  textures,  or  much  attraction 
for  water,  whence  they  effect  few  changes  in  the  organic  constituents  of 
the  body. 

AVhile  they  all  act  as  purgatives,  producing  watery  evacuations,  they 
excite  very  little  irritation  in  the  mucous  membrane. 

How  do  they  produce  their  purgative  effect  ? 

Purgatives  may  act  in  one  of  two  ways,  or  in  both  combined. 

Some  purge  by  increasing  the  moisture  of  the  intestines,  and  so  facili- 
tating the  passage  of  the  contents  along  the  canal;  others  act  by  increas- 
ing the  peristaltic  action  of  the  intestines,  so  that  the  contents  are  urged 
more  rapidly  towards  the  rectum ;  whilst  most  purgatives  combine  both 
modes,  although  one  action  usually  predominates. 

The  watery  character  of  the  motions  shows  without  doubt  that,  in  part 
at  least,  these  drugs  purge  by  augmenting  the  moisture  of  the  contents  of 
the  intestines — an  augmentation  effected  in  three  wa3's:  by  causing  water 
to  flow  from  the  blood  into  the  intestines;  by  exciting  the  mucous  glands 
of  this  tract  to  increased  secretion;  or  by  effecting  the  retention  of  the 
water  already  present  in  the  intestines,  Buchheim  concludes,  from  his 
careful  observations,  that  these  salts  purge  solely  in  virtue  of  their  power 
to  retain  in  the  intestines  the  water  existing  there,  producing  no  flow  of 
fluid  from  the  blood,  no  increased  secretion  from  the  mucous  glands, 
shown  bv  the  fact  that,  after  purgation  Avith  these  medicines,  no  albu- 
minous substances  are  found  in  the  faces, 

Thiry  and  Radziejewski  conclude  that  these  salts  and  other  purgatives 
act  by  increasing  the  peristaltic  action,  especially  of  the  large  intestine. 
Brunton  has  shown  that  a  solution  of  sulphate  of  magnesia  does  cause 
fluid  to  pass  from  the  blood  to  the  intestine,  for,  Avhen  a  solution  of  sul- 
phate of  magnesia  is  put  into  a  knuckle  of  intestine  secured  at  both  ends, 
it  is  found  tliat  after  some  hours  the  contents  of  the  bag  are  increased, 
and  the  question  arises  whether  this  augmentation  is  due,  according  to 
the  old  view,  to  simple  osmosis  from  the  blood,  or  is  due,  as  Brunton 
thinks,  to  stimulation  of  the  mucous  membrane  of  the  intestine.  AVlien 
we  bear  in  mind  how  an  irritant  like  snuff  or  pepper  applied  to  the  nose 
and  eyes  causes  a  copious  flow  from  these  parts,  we  can  easily  conceive 
that  stimulation  will  cause  a  copious  outpour  into  the  intestine.  Moreau 
has  shown  that  section  of  the  intestinal  nerves  causes  a  free  serous  exuda- 
tion into  the  intestine,  but  it  does  not  appear  that  paralysis  of  these  nerves 
explains  the  purgative  action  of  salines.  The  stools  provoked  by  salines 
do  not  contain  albumen,  as  they  would  were  the  excess  of  water  they 
contain  due  to  serous  exlidation. 


SULPHATES.  161 

In  an  elaborate  and  valuable  paper,  Dr.  MattheAV  Hay  has  re-investi- 
gated the  mode  by  which  saline  cathartics  act.  His  experiments  show 
that  saline  purgatives  act  by  exciting  an  increased  secretion  from  the 
mucous  membrane,  chiefly  of  the  small  intestine,  and  the  increase  in  the 
contents  of  the  intestinal  canal  is  not  due  to  an  increased  pancreatic  or 
biliary  secretion.  This  increase  in  the  quantity  of  fluid  in  the  intestine 
is  a  true  secretion,  and  not  due  to  inflammatory  irritation  nor  to  osmosis, 
for  the  intestines  are  not  congested,  and  the  fluid  in  the  intestines  only 
contains  a  trace  of  albumen,  and  the  quantity  of  fluid  in  the  intestines  a 
short  time  after  the  administration  of  the  saline,  compared  with  the  qvian- 
tity  of  salt  absorbed,  is  far  too  large  to  be  explained  by  osmosis. 

The  saline  passes  rapidly  along  the  small  intestine  to  the  colon,  and 
almost  the  whole  of  the  fluid  reaches  the  colon  of  a  fasting  animal  iij  an 
hour.  Food  probably  delays  the  passage  of  the  fluid,  and  so  weakens  the 
purgative  action. 

The  saline  is  absorbed  by  the  small  intestine,  but  excreted  by  the 
colon,  hence  whilst  the  fluid  is  in  largest  quantity  in  the  small  intestine 
and  becomes  rather  less  as  the  contents  pass  downwards,  the  salt  is  less  in 
the  small  intestines,  and  is  in  larger  quantity  in  the  colon.  The  purga- 
tive action  is  not,  however,  caused  by  the  secretion  of  the  saline  by  the 
colon,  for,  when  injected  into  a  vein,  sulphate  of  soda  and  sulphate  of 
magnesia  do  not  purge. 

He  finds  the  absorption  of  these  salts  very  slow  from  the  stomach,  but 
rapid  in  the  small  intestines. 

Magnesium  sulphate  he  finds  much  more  poisonous  to  the  respiratory 
centre  and  the  heart  when  injected  into  a  vein  than  sodium  sulphate. 

Like  other  purgatives,  these  salts  are  used  to  evacuate  the  bowels,  to 
remove  water  and  poisonous  matters  from  the  blood  and  to  reduce  blood- 
pressure.  As  simple  evacuants,  they  prevent  contamination  of  the  blood 
by  removing  the  alkaloids  and  other  poisonous  substances  generated  from 
the  fa?ces  in  the  intestine. 

Owing  to  their  increasing  secretion  from  the  intestines  and  their  in- 
fluence in  retaining  fluids  in  the  intestinal  canal,  these  salts  remove  im- 
purities, like  those  which  occur  in  ureemia,  jaundice,  etc.  Further,  by 
freely  removing  fluid  from  the  blood,  and  by  dilating  the  abdominal 
vessels,  they  lower  blood-pressure.  Hence  saline  purgatives  are  often 
used  with  advantage  in  bleeding  from  the  lungs. 

An  excellent  way  to  administer  some  of  these  salts  is  in  the  form  of 
Pullna,  Friedrichshall,  or  yEsculap  water^  in  doses  varying  from  a  wine- 
glassful  to  half  a  tumblerful  or  more.  Usually  one  dose  before  breakfast 
is  sufficient;  if  not,  a  second,  and  even  a.  third,  dose  maybe  taken  in  the 
course  of  the  day.  It  is  advisable  to  mix  the  natural  water  with  a  third, 
or  an  equal  quantity  of  boiling  water;  for  when  taken  cold,  it  is  some- 
times liable  to  "  lie  heavy  on  the  stomach,"  Usually  a  wine-glassful  of 
one  of  these  waters,  with  an  equal  quantity  of  hot  water,  is  sufficient  to 
open  the  bowels  without  much  griping  or  pain. 

A  wine-glassful  of  Friedrichshall  water  in  a  breakfast-cupful  of  hot 
water  is  very  useful  in  bilious  sick  headache.  The  best  time  is  before 
breakfast,  though  it  is  useful  at  any  time.  It  stays  the  nausea  and  soon 
relieves  the  headache,  sometimes  without  purging.  The  taste  of  this  mix- 
ture is  not  very  disagreeable.  Pullna  or  Friedrichshall  water  mixed  with 
milk  is  a  good  purgative  for  children,  the  milk  disguising  the  bitterness. 

An  orange  or  two  eaten  before  breakfast  is  a  pleasant  and  often  effec- 
11 


162  SULPHATES. 

tual  way  of  overcoming  moderate  habitual  constipation;  and  sometimes, 
indeed, "this  plan  overcomes  the  most  obstinate  forms.  xVnother  good 
means  of  obviating  consti2)ation  is  to  take  a  glass  of  cold  water  before, 
and  an  orange  soon  after,  breakfast,  and  if  oranges  before  breakfast  dis- 
agree, the}'  should  be  taken  soon  after  it. 

Stewed  rhubarb,  or  stewed  gooseberries,  cooked  or  uncooked  apples, 
are  effectual;  grapes  and  strawberries,  on  the  other  hand,  are  often  use- 
less. Strange  to  say,  we  occasionally  meet  with  people  in  whom  fruit 
causes  constipation.  Again,  we  see  individual  peculiarities  in  respect  of 
fruit.  Thus,  some  are  made  bilious  by  oranges  or  strawberries;  some  are 
constipated  by  strawberries,  whilst  other  fruit  relaxes. 

There  are  many  persons,  esjiecially  busy,  worried  men,  whose  com- 
fort iind  well-being  seem  to  depend  on  an  efficient  daily  evacuation  of  the 
bowels.  If  they  pass  a  day  without  relief  of  the  bowels,  or  if  the  defeca- 
tion is  delayed  to  the  after  part  of  the  day,  they  suffer  from  mental  dul- 
ness  and  inactivity,  a  kind  of  fogginess,  with  mucii  irritability,  and  per- 
haps a  dull,  "stupid"  headache.  They  are  quice  conscious  of  their 
irritability,  but  cannot  well  control  it.  Directly  the  bowels  act  freely, 
these  symptoms  vanish  at  once,  the  head  clears,  the  spirits  revive,  the 
ill- temper  disappears,  they  recover  their  full  mental  capacity,  and  in  a 
short  time  longer,  perhaps  half  an  hour  or  an  hour,  the  headache  dis- 
apj)ears.  With  many  such  patients  the  constipation  is  not  obstinate, 
but  they  pass  daily  a  hardened,  dry  evacuation,  insufficient  to  give  com- 
fort. Porridge,^jrown  bread,  whole-meal  bread,  and  exei'cise  are  generally 
sufficient  to  overcome  the  constipation.  If  not,  then  fruit  before  or  after 
breakfast  should  be  tried,  and  this  failing,  the  natural  purgative  waters 
will  often  prove  useful. 

Carlsbad  waters  are  eminently  useful  in  many  abdominal  diseases. 
The  imported  Avaters  are  esj)ecially  efficr.cious  when  a  dietary  is  adopted 
similar  to  that  enjoined  at  Carlsbad.  The  vrater  should  be  warmed  to 
about  100°  to  110°,  and  the  patient  must  drink  three  to  six  tumblerfuls 
before  breakfast,  prolonging  the  drinking  over  an  hour  or  more,  and  if 
j)ossible,  whilst  taking  exercise  in  the  open  air.  Dr.  Stephen  "Ward  says, 
"Even  when  first  taken,  and  in  moderate  quantity,  they  usually  cause 
pulpy  slimy  stools  of  dark  color  and  offensive  odor.  These  stools  are 
generally  frequently  repeated,  and  the  patient  is  astonished  at  the  quan- 
tity that  sometimes  comes  aAvay,  but  in  many  persons  no  very  evident 
symptoms  beyond  the  purgative  action  attend  the  drinking  of  the  waters." 
I  have  rarely  seen  them  purge,  because,  perhaps,  I  havechiefly  used  them 
in  obstinate  constipation.  The  cpiantity  to  be  taken  depends  on  their 
effects.  It  is  better  to  begin  with  three  tumblerfuls  and  gradually  increase 
the  quantity  to  four,  five,  or  six,  according  to  the  action.  This  treatment 
must  be  continued  three  weeks  or  a  month.  It  often  induces  some  weak- 
ness. It  reduces  stoutness,  and  sometimes  even  makes  a  jiatient  very 
thin.  But  if  it  produce  much  depression,  or  excite  nervous  symptoms, 
a  smaller  quantity  must  be  taken,  and  the  course  must  be  limited  to  a 
fortnight  or  three  weeks.  The  good  effects  are  sometimes  not  appar- 
ent till  a  week  or  so  after  the  course.  The  diet  at  Carlsbad  is  extremely 
simple.  "  Fat,  butter,  cream,  pastry,  cheese,  rich  meats,  as  pork,  goose, 
sausages,  salmon,  mackerel,  herrings,  anchovies,  entrees,  and  other  dishes 
seasoned  with  spices,  pepper,  onions,  garlic,  etc.,  are  to  be  avoided.  Dressed 
salads,  cucumber,  and  uncooked  fruit  generally  are  objected  to  as  being 
indigestible,  and  likely  to  cause  flatulence  and  irritation  of  the  bowels. 


SULPHATES.  163 

The  use  of  spirits  is  absolutely  forbidden,  and  the  wine  of  the  country 
or  the  lighter  French  wines  are  permitted  only  sparingly,  and  in  cases 
especially  requiring  a  certain  amount  of  stimulus.  The  breakfast,  which  is 
usually  taken  about  an  hour  after  drinking  the  last  cup  of  water,  consists 
merely  of  weak  tea  or  coffee,  Avith  milk  and  a  little  sugar,  and  small  well- 
baked  rolls,  or  second  day's  bread;  meat,  fish,  or  eggs  being  excluded,  ex- 
cept for  the  very  delicate.  The  dinner,  which  takes  place  at  one,  consists 
of  but  three  courses;  soup,  free  from  grease  and  spices,  and  thickened 
with  barley,  rice,  or  vermicelli;  meat,  as  beef,  mutton,  lamb,  poultry,  or 
game,  with  well-boiled  fresh  vegetables;  and  a  light,  simple  jjudding,  or 
a  compote  of  stewed  fruit;  a  cup  of  coffee  may  be  taken  in  the  afternoon; 
a  light  supper  is  takenat  eight  o'clock;  and  smoking  in  moderation  is  not 
objected  to.''     (Dr.  Stephen  Ward.) 

This  treatment  is  extremely  useful  in  obstinate  habitual  constipation, 
and  by  its  means  I  have  cured  some  of  the  most  rebellious  cases.  In  such 
instances  it  may  not  relieve  the  bowels  for  some  days,  indeed  even  a 
week  may  pass  without  relief;  in  other  cases  it  at  once  produces  one  or 
two  soft,  copious,  natural  evacuations,  and  on  discontinuing  the  water, 
the  bowels  act  daily.  After  some  months,  however,  a  recourse  to  the 
waters  may  again  become  necessary,  owing,  generally,  to  some  fault  in 
the  patient's  habits.  In  cases  of  simple,  obstintite  constipation,  it  is  not 
necessary  to  enforce  very  strictly  the  rigorous  Carlsbad  regimen  just 
described. 

Again,  in  cases  like  the  following,  Carlsbad  waters  are  very  useful : — 
a  middle-aged  woman,  accustomed  to  eat  and  drink  somewhat  too  freely, 
suffers  from  acidity,  much  flatulence,  constipation  with  attacks  of  pain 
at  the  epigastrium,  or  over  the  liver,  or  between  the  shoulders,  the  con- 
junctiva becoming  rather  jaundiced,  and  the  complexion  sallow.  In  a 
case  like  this,  a  well-regulated  diet  greatly  assists  the  action  of  the 
waters.  This  treatment  is  also  very  useful  in  gall-stones  and  gout.  It 
is  the  most  successful  treatment  for  the  removal  of  gall-stones,  and  the 
prevention  of  their  formation.  Patients  sometimes  say  they  have  tried 
Carlsbad  waters  without  good  results,  when  they  have  simply  taken 
Carlsbad  salts  dissolved  in  a  small  quantity  of  water.  In  such  a  form 
the  Glauber  salts  purge,  but  fail  to  yield  the  same  excellent  results,  as 
when  given  largely  diluted  with  water;  I  have  no  doubt  that  the  large 
bulk  of  water  plays  a  prominent  part  in  the  therapeutic  effects. 

Some  members  of  this  group,  as  sulphate  of  soda,  bitartrate  of  pot- 
ash, and  tartrate  of  potash  and  soda,  owing  to  their  hydrogenic  action, 
are  largely  used  in  general  dropsy,  both  cardiac  and  renal.  Owing  to 
their  action  in  largely  increasing  intestinal  secretion,  and  to  a  less  ex- 
tent to  their  action  in  retaining  fluid  in  the  intestinal  canal,  they  lessen 
dropsy,  and  so  free  in  some  measure  the  water-logged  organs,  and  thus 
remove  many  distressing  symptoms;  for  instance,  in  the  case  of  Bright's 
disease,  the  fluid  withdrawn  from  the  blood  holds  in  solution  some  of  the 
deleterious  matters  that  produce  urasmia.  These  purgatives,  therefore, 
purify  the  blood,  and  thus  assist  in  controlling  coma,,  convulsions,  head- 
ache, sickness,  etc.  It  must,  however,  be  borne  in  mind  that  often 
repeated  pifrgation  is  weakening,  and  may,  by  increasing  anaemia,  actu- 
ally subsequently  increase  dropsy. 

The  purgative  action  of  these  salts  is  most  marked  when  adminis- 
tered in  a  concentrated  condition,  and  Hay  advises  giving  six  drachms  to 
an  ounce  of  suij)hate  of  magnesia  in  an  ounce  of  w.iter  before  food,  and 


164  SULPHATES. 

directs  abstention  from  fluids  for  some  time  afterwards.  This  treatment 
withdraAvs  much  water  from  the  blood-vessels,  and  speedily  reduces 
dropsies,  general  rather  than  local.  He  recommends  this  treatment  in 
pleuritic  effusion. 

A  brisk  purgative  frequently  promotes  free  and  abundant  secretion 
from  the  kidneys,  either  Avhen  healthy  or  diseased;  and,  herein  we  have 
perhaps,  further  elucidation  of  the  good  effects  of  these  remedies  in 
Bright 's  disease. 

Some  member  of  this  group,  generally  either  siilphate  of  magnesia  or 
phosphate  of  soda,  is  often  given  as  an  intestinal  evacuant  in  fever; 
hence  they  are  reputed  to  be  febrifuge.  But  their  action  is  due  simply 
to  the  unloading  of  the  bowels,  since  it  is  well  known  that  constipation 
augments  the  preternatural  fever  heat. 

For  fever  patients,  Dr.  Armstrong  strongly  recommended  free  pur- 
gation, to  the  extent  of  several  evacuations  daily,  during  the  first  few 
days,  before  exhaustion  sets  in.  This  treatment  still  finds  just  favor 
with  many  practical  authorities,  although  it  is  not  ajiproved  by  Dr. 
Graves.  It  is  considered  that  free  purgation  in  scarlet  fever  prevents 
severe  sore-throat,  glandular  swellings,  discharges  from  the  nose  and 
ears,  with  many  other  disagreeable  sequelte. 

In  measles,  purgatives  must  be  given  with  caution,  the  bowels  being 
generally  irritable,  and  diarrhrea  often  present. 

Eutherford,  from  his  experiments  with  fasting  dogs,  finds  that 
jihosphate  of  soda  is  a  powerful  cholagogue,  not  merely  emptying  the 
gall-bladder  and  biliary  ducts,  but  actually  increasing  the  secretion  of 
bile.  Sulphate  of  potash  and  Eoelielle  salts  he  finds  moderate  chola- 
gogues,  whilst  sulphate  of  soda  is  only  a  feeble  he^^atic  stimulant. 
Strange  to  say,  he  finds  that  sulphate  of  magnesia  produces  no  effect  on 
the  liver.  It  is  interesting  to  observe  that  sulj^hate  of  soda  is  the  chief 
ingredient  in  Carlsbad  water,  so  largely  used  for  its  action  on  the  liver. 

Dr.  Bartholow  sj^eaks  highly  of  j)hos2Dhate  of  soda  in  catarrhal  jaun- 
dice; a  drachm  three  times  a  day  to  adults,  ten  grains  for  children.  He 
commends  it  also  in  hepatic  colic,  to  prevent  the  formation  of  gall- 
stones. In  biliary  colic  the  treatment  should  be  persisted  in  for  several 
months.  He  also  strongly  recommends  ten  grains  several  times  a  day  in 
milk,  passing  the  pasty  white  stools  of  ill-conditioned  children. 

On  account  of  the  low  diffusion-power  of  these  salts,  very  little  passes 
into  the  blood,  the  greater  part,  especially  when  they  purge,  passing 
from  the  system  with  the  freces.  Small  doses,  if  they  tarry  long  in  the 
intestines,  ultimately  pass  into  the  blood,  and  are  separated  by  the  kid- 
neys. They  are  reputed  to  act  as  diuretics.  The  tartrates  of  this  group 
are  highly  esteemed  as  excellent  diuretics  in  Brighfs  disease,  and  are 
often  employed  in  doses  short" of  purging.  The  tartrates  and  bitartrates 
are  converted  into  carbonates  partly  in  the  intestines  and  partly  in  the 
blood.  They  thus  lessen  the  acidity  of  the  urine  or  even  render  it  alka- 
line. Except  in  the  case  of  phosphate  of  soda,  the  action  of  these  salts 
on  the  constituents  of  the  urine,  either  in  health  or  disease,  has  not  yet 
been  worked  out. 

The  salts  of  this  group  most  frequently  employed  are  the  bitartrate 
of  potash,  sulphate  of  magnesia,  and  ])hosphate  of  soda.  This  phosphate, 
well-nigh  tasteless,  may  be  given  to  children,  unsuspected,  in  a  little  broth. 

Like  other  purgatives  these  salts  often  act  quicker  and  with  greater 
certainly  in  small  and  frequently-repeated   doses.      Hence,  when  the 


NITRATES.  165 

bowels  are  tightly  locked  up,  having  resisted  the  action  of  a  full  dose  of 
Epsom  salt,  it  is  a  good  practice  to  give  the  same  remedy  in  small  and 
often  rejjeated  quantities,  as  a  drachm  every  hour  or  two  hours. 

It  should  be  mentioned  that  sulphate  of  potash  must  be  given  with 
some  caution,  for,  although  usually  a  safe  and  mild  purgative,  it  has 
proved  in  some  cases  poisonous,  potash  salts  being  far  more  poisonous 
than  soda  or  magnesium  salts. 


NITRATE   OF   POTASH,   NITEATE   OF   SODA. 

These  salts  possess  a  very  high  diffusion-power,  and  are  freely  solu- 
ble in  water.  They  lower  the  temperature  of  water,  an  effect  very  con- 
siderably increased  if  sal  ammoniac  is  mixed  with  the  nitre.  This  com- 
bination of  salts  used  to  be  aj)plied  to  the  skin  as  a  refrigerator,  though 
now  it  is  rarely  so  emi^loyed,  and  is  to  be  especially  avoided  if  the  skin 
is  broken,  as  solutions  of  the  nitrate  are  very  irritating  to  the  wounds. 
Ice  is  in  every  way  a  better  refrigerator. 

The  inhalation  of  the  fumes  of  burnt  nitre  paper  will  sometimes 
avert  the  paroxysm  of  asthma.  According  to  Dr.  Hyde  Salter  this  treat- 
ment is  most  effectual  in  pure  uncomplicated  asthma.  He  points  out 
that  the  paper  must  not  imbibe  too  much  nor  too  little  nitre.  If  the 
bibulous  paper  is  too  thin,  it  absorbs  insufficient  nitre;  if  too  thick,  it 
takes  up  excess  of  nitre,  and  the  fumes  are  too  carbonaceous,  the  paper 
burning  too  fast,  with  a  sudden  explosive  flame.  There  should  be  no 
brown  smoke,  but  clear  white  fumes.  Red  blotting  paper  of  moderate 
thickness  and  loose  texture  is  best.  Dr.  Salter  gives  the  following  di- 
rections for  the  manufacture  of  nitre-paper: — Dissolve  four  ounces  of 
nitre  in  half  a  pint  of  boiling  water;  pour  the  liquid  into  a  small  waiter 
and  soak  the  paper,  then  drain  and  dry  it.  Cut  it  into  pieces  four  inches 
square,  and  when  required  burn  one  or  two  of  these  pieces,  or  a  piece 
may  be  burnt  nightly  in  the  bedroom.  The  prepared  paper  mast  be 
kept  in  a  dry  place.  In  the  Pharmacopoeia  of  the  Throat  Hospital,  Sir 
Morell  Mackenzie  gives  the  preparation  of  three  papers  of  different 
strength,  one  made  from  a  solution  containing  sixty  grains,  another  forty 
grains,  and  the  third  thirty  grains  of  nitre  to  an  ounce  of  water.  He 
directs  the  paper  to  be  cut  into  pieces  three  inches  long  and  half  an 
inch  broad,  and  one  to  six  of  these  pieces  to  be  used  successively  at  each 
inhalation.  The  paper  is  buriied  in  a  Jar,  and  the  fumes  inhaled  by  tak- 
ing deep  inspirations  from  the  fuming  vessel.  Variotis  substances  may 
be  added  to  the  solution  which  appear  in  some  instances  to  heighten 
the  effect  of  the  nitre,  such  as  compound  tincture  of  benzoin,  spirits  of 
camphor,  oil  of  cassia,  and  tincture  of  sumbul.  It  is  a  singular  circum- 
stance, affording  a  marked  example  of  the  "  caprice  "  of  asthma,  that  a 
paper  prepared  with  nitre  only  will  relieve  one  patient,  yet  will  utterly 
fail  to  relieve  another,  although  a  nitre  paper  prepared  in  a  different 
manner  may  be  quite  successful.  It  must  be  borne  in  mind,  therefore, 
that  although  one  kind  of  nitre-paper  has  failed,  it  does  not  necessarily 
follow  that  another  sort  of  nitre  paper  will  also  fail.     Sometimes  a  thin 


106  NITRATES. 

paper  fails  where  a  thick  one  succeeds,  or  vice  verHd.  It  appears,  indeed, 
that  very  slight  differences  in  the  mode  of  manufacture  influence  the 
therapeutic  effects.  Many  quack  papers  said  to  contain  other  substances 
besides  nitre,  or  besides  nitre  and  clilorate  of  potash,  often  succeed  ad- 
mirably. 

A  considerable  recent  experience  leads  me  to  conclude  that  these 
papers  would  prove  much  more  relieving  if  somewhat  differently  pre- 
pared, and  if  pieces  were  burned  sufficiently  large  to  fill  the  room  with 
fumes.  The  most  efficacious  paper  is  made  by  dijjping  ordinary  white 
blotting  jDajDer  in  a  boiling  saturated  solution  of  nitrate  of  potash  and 
chlorate  of  potash.  Paper  thus  j^repared  burns  with  a  flame.  A  large 
piece,  the  size  of  course  depending  on  the  dimensions  of  the  room,  often 
succeeds  when  other  prepared  papers  fail.  A  piece  ten  inches  square, 
and  sometimes  two  or  three  jiieces  are  required.  When  ordinary  papers 
have  failed,  I  have  recently  used  in  some  cases  with  advantage  a  pastile 
compounded  of  two  parts  of  nitre,  one  part  of  chlorate  of  potash,  with 
two  parts  of  lycopodium  jjowder.  Dr.  Murrell  uses  with  much  success  a 
thick  paper  soaked  in  a  boiling  saturated  solution  of  nitre  and  chlorate 
of  potash.  This  thick  paper,  made  by  the  adhesion  of  six  sheets  during 
crystallization,  contains,  when  dry,  twice  its  own  weight  of  salt,  and  a 
piece  of  paper  six  inches  square* takes  up  nearly  half  an  ounce  of  the 
mixed  salt.  Certain  cases  require  a  greater  quantity  of  nitre  smoke  than 
others.  I  am  convinced  that  the  reason  why  papers  appear  in  so  many 
cases  to  fail,  is  that  they  are  not  adequately  imjDregnated  with  nitre,  and. 
are  consumed  too  sparingly. 

The  crystals  of  nitre  have  a  cooling  saline  taste,  and  in  acute  inflam- 
mation of  the  throat  are  sometimes  sucked,  but  other  remedies  are  j^ref- 
erable. 

In  large  doses  the  nitrates  inflame  the  stomach.  Even  when  taken 
for  some  time  in  moderate  quantities  they  considerably  disorder  diges- 
tion, producing  nausea,  vomiting,  and  a  coated  tongue:  consequently 
their  action  must  be  carefully  watched. 

From  their  high  diff'usion-power  these  salts  speedily  enter  the  circu- 
lation. Unless,  indeed,  large  quantities  are  taken  they  pass  but  a  short 
way  along  the  intestines,  and  therefore  do  not  purge,  and.  indeed,  so  far 
as  we  know  at  present,  exert  little  or  no  direct  influence  on  either  the 
small  or  large  intestines. 

Much  conjecture  has  been  hazarded  regarding  the  action  of  the  nitrates 
on  the  blood.  It  is  well  known  that  they  prevent  the  coagulation  of  the 
fibrin  in  blood  withdrawn  from  the  body,  or,  when  coagulated,  dissolve 
it.  Scherer,  however,  asserts  that  they  will  not  dissolve  the  fibrin  of  in- 
flammatory blood.  These  facts  have  led  to  the  supposition  that  the 
nitrates  may  possess  a  like  influence  over  fibrin  in  the  circulation,  and 
th;it  they  are  indicated  when  this  substance  is  in  excess,  as  in  inflamma- 
tions and  acute  rheumatism.  There  is  no  proof,  however,  that  the  ni- 
trates possess  any  such  power,  and,  indeed,  unless  employed  in  consider- 
able quantities,  they  exert  very  little  influence  upon  fibrin  out  of  the  body. 
Hence  it  cannot  be  expected  that  after  its  dilution  with  the  fluids  of  the 
circulation,  harmless  doses  can  in  any  Avay  influence  the  fibrin  of  the 
blood.  But,  indeed,  this  notion  is  no  longer  tenable,  for  it  has  been 
ascertained  that  blood  withdrawn  from  the  body,  both  before  and  after 
the  administration  of  nitrate  of  potash,  contains  in  each  case  the  same 
quantity  of  fibrin. 


NITRATES.  1G7 

These  salts  are  considered  to  be  liiglily  useful  in  acute  rheumatism, 
and  are  supj^osed  to  jirotect  the  valves  of  the  heart,  or  to  restore  them 
to  their  natural  state  when  damaged  by  rheumatism,  a  supposition 
founded  on  a  misapprehension  of  the  morbid  j^rocesses  which  lead  to 
valvular  contraction  and  incompetency.  These  structural  changes,  it 
was  imagined,  resulted  from  the  depositions  of  fibrin  on  the  surface  of 
the  valves,  and  the  subsequent  contraction  of  this  substance  rendered 
them  shrunken  and  inefficient,  the  truth  being  that  these  changes  in 
the  valves  are  owing  to  inflammatory  products  formed  in  their  own  sub- 
stance. Occasionally,  it  is  true,  fibrin  is  deposited  on  thickened  and 
roughened  valves,  but  even  this,  as  has  just  been  pointed  out,  these  salts 
can  neither  prevent  nor  remove. 

While  it  must  be  admitted  that  these  salts  do  not  act  in  the  way 
supposed,  many  high  authorities  consider  that  nitre  mitigates  and  short- 
ens an  attack  of  rheumatism.  The  advocates  of  nitre  administer  it  in 
large  doses,  freely  diluted  in  water,  giving  as  much  as  half  an  ounce  to 
an  ounce  of  the  salt  in  the  course  of  the  day  in  lemonade  or  barley-water 
agreeably  sweetened.  The  urine,  it  is  said,  becomes  very  abundant  when 
the  fever  declines,  and  the  pains  abate.  At  present  there  are  no  obser- 
vations sufficiently  exact  to  determine  this  point,  Nitrates  are  now 
quite  superseded  by  salicylate  of  soda  in  acute  rheumatism. 

The  same  discrepancies  of  opinion  prevail  regarding  the  influence 
of  the  nitrates  on  acute  inflammation. 

Large  doses  produce  pains  in  the  stomach,  with  vomiting  and  diar- 
rhoea, great  weakness,  faintings,  loss  of  consciousness,  and  death.  The 
same  symptoms  are  witnessed  in  a  minor  degree  when  less  immoderate 
quantities  are  used.  The  patient  becomes  languid,  disinclined  to  exert 
either  body  or  mind,  and  the  pulse  is  feeble  and  slow. 

These  salts  readily  pass  from  the  body  through  the  kidneys  with  the 
urine,  and  in  their  passage  may  irritate  and  inflame  the  urinary  organs, 
and  in  large  doses  may  even  produce  bloody  urine. 

Nitrate  of  potash  has  been  recommended  in  the  incontinence  of 
urine  of  children. 

In  some  quarters  they  enjoy  a  very  high  reputation  as  diuretics,  and 
in  certain  cases  appear  to  be  of  considerable  service.  Their  diuretic 
action  is  well  displayed  in  lumbago  and  chronic  rheumatism;  accom- 
panied by  scanty  high-colored  urine,  which  becomes  turbid  on  cooling. 
Ten  grains  of  the  salt  dissolved  in  water,  taken  hourly  or  every  two 
hours,  in  some  cases  will  soon  increase  tlie  urine,  rendering  it  clear  and 
limpid,  when  the  rheumatic  pains  generally  decline. 


168  CHLORATE    OF    POTASH. 


CHLORATE   OF   POTASH. 

In  many  of  its  chemical  properties  Chlorate  of  Potash  corresponds 
to  the  preceding  group  of  nitrates;  like  them,  endowed  with  a  high  dif- 
fusion-power, it  differs  in  its  sparing  solubility. 

A  solution  of  the  chlorate,  used  as  a  wash,  is  said  to  clean  and  stim- 
ulate foul  ulcers;  but  other  remedies  are  more  effective. 

This  salt  appears  to  increase  the  flow  of  the  saliva,  and,  according  to 
Hutchinson  and  others,  to  produce  ulceration  of  the  mucous  membrane 
of  the  mouth.  It  is  largely  used  in  various  affections  of  the  mouth,  and 
is  of  signal  service  in  mercurial  and  simple  salivation,  in  ulcerative  sto- 
matitis and  aphthae.  It  is  particularly  useful  in  the  ulceration  of  the 
edges  of  the  gums,  generally  limited  to  one  side  of  the  mouth,  affecting 
both  the  upper  and  lower  Jaws,  also  that  part  of  the  tongae  and  cheeks 
coming  in  contact  with  the  ulcerated  gums.  Although  not  at  all  dan- 
gerous, it  is  often  a  very  obstinate  complaint,  especi;illy  Avith  adults, 
though  children  are  most  prone  to  it.  The  influence  of  the  chlorate  on 
this  form  of  ulceration  is  almost  magical;  in  one  or  two  days  it  cleans 
the  dirty  looking  ulceration,  and  heals  it  in  a  day  or  two  more.  It  is 
said  to  cure  follicular  and  phagedenic  ulceration  like  a  charm.  Dr.  Lloyd 
Eoberts  says  that  chlorate  of  potash,  taken  internally,  and  used  as  a 
lotion,  is  useful  in  the  teazing  dryness  of  the  mucous  membrane  of  the 
throat  left  after  diphtheria  and  scarlatina. 

It  is  largely  used  in  full  doses  in  diphtheria,  acute  sore-throat,  and 
scarlatina. 

Dr.  Leonard  Sedgwick  speaks  highly  of  chlorate  of  potash  in  catarrh; 
he  says  it  quickly  relieves  stuffing  of  the  nose,  rawness  of  the  throat, 
and  thickness  of  voice.  Taken  early  and  frequently,  it  will  stop  many  a 
cold.     Eight  or  ten  lozenges  should  be  sucked  in  the  twenty-four  hours. 

Some  assert  that  the  action  of  chlorate  of  potash  is  simply  local,  and 
that  its  good  effects  are  all  due  to  its  topical  application.  AVhen  ad- 
ministered by  the  stomach,  it  is  largely  excreted  by  the  salivary  glands; 
hence  after  absorption  its  to^ncal  action  in  the  mouth  and  throat  j^ersists. 

Chlorate  of  soda  is  more  soluble  than  chlorate  of  potash,  and  appears 
to  be  equally  serviceable. 

Chlorate  of  potash  seems  to  produce  but  little  effect  oii  the  stomach, 
unless  taken  in  considerable  quantities,  when,  like  the  nitrates,  it  in- 
flames the  mucous  membrane,  and  produces  both  vomiting  and  diarrhcea. 
It  is  not  employed  in  diseases  of  the  stomach. 

Owing  to  its  high  diffusion-power  it  passes  readily  into  the  blood, 
but  owing  to  its  slight  solubility,  a  large  quantity  of  this  salt  cannot 
find  its  way  quickly  into  the  circulation.  Nevertheless,  it  has  proved 
poisonous,  especially  in  children.  In  poisonous  doses,  as  half  an  ounce 
to  an  adult,  it  inflames  the  gastro-intestinal  canal  and  excites  violent 
vomiting  and  profuse  diarrhoea,  acting  like  nitrates  and  some  other  sub- 
stances. It  profoundly  modifies  the  blood  corpuscles,  changing  the 
oxyhsemoglobin  to  methtemoglobin,  and  induces  cyanosis  with  cardiac 
weakness,  sometimes  delirium,  coma  with  cramps,  and  a  peculiar  stiffness 
of  the  extremities.  It  also  disintegrates  many  of  the  red  corpuscles, 
and  the  coloring  matter  with  albumen,  and  some  blood  corjmscles,  es- 
cape Avith  the  urine,  the  coloring  matter  existing  in  part  as  metha?mo- 
globin  and  in  part  as  oxyha^moglobin.  The  urine  also  contains  the  col- 
oring matter  in  the  form  of  granular  red  or  brownish-red  casts.     The 


ALUM.  1G9 

quantity  of  the  urine  is  diminisliecl;  it  therefore  induces  a  condition 
quite  similar  to  paroyxsmal  liaemoglobinuria.  Small  ecchymoses  some- 
times appear  in  the  skin,  and  general  jaundice  sometimes  occurs.  Owing 
to  the  gastro-intestinal  catarrh  the  patient  complains  of  pain  and  ten- 
derness of  the  abdomen.  The  liver  is  also  enlarged.  At  the  post-mortem 
the  blood  is  found  of  a  chocolate  color,  the  liver  and  spleen  are  enlarged, 
and  with  the  marrow  of  the  bones,  contain  much  debris  of  the  disinte- 
grated red  corpuscles.  Nephritis  is  also  present,  and  the  kidney  tubules 
are  full  of  brown  casts. 

As  this  salt  easily  parts  with  oxygen,  it  was  at  one  time  supposed 
that,  by  yielding  up  this  element  to  the  blood  and  tissues,  it  might  pro- 
mote oxidation;  but  careful  observations  have  conclusively  proved  the 
erroneousness  of  this  view,  as  the  salt  can  be  obtained  unaltered  from 
the  urine. 

It  has  been  recommended  in  facial  neuralgia. 

Its  influence,  if  any,  on  the  organs  of  the  body  is  unknown.  Half 
an  ounce  to  an  ounce  of  a  saturated  solution  containing  five  to  ten  drops 
of  laudanum  is  very  useful  as  an  injection  for  inflamed  and  painful  piles. 


ALUM,   DEIED   ALUM,   ACETATE   OF  ALUMINA. 

These  salts  are  employed  almost  exclusively  as  topical  astringents. 

They  act  as  astringents  in  virtue,  it  is  supposed,  of  their  capacity  to 
unite  with  albumen,  and  coagulate  it. 

They  produce  no  effect  on  the  entire  skin;  but  when  applied  to  sores, 
they  coagulate  the  albumen  of  the  pus,  mucus,  or  of  the  tissues  them- 
selves, thus  coating  the  sore  with  an  impermeable  layer,  and  protecting 
it  from  the  action  of  the  air.  Like  the  salts  of  many  other  metals,  alum 
may  be  used  to  form  this  protective  coating.  These  agents  have  a  further 
action  than  that  just  described;  for,  as  just  stated,  they  act  as  astringents 
by  combining  with  and  condensing  the  tissues.  The  topical  application 
of  alum  contracts  the  blood-vessels,  and  lessens  the  supply  of  blood  to  a 
sore.  By  constringing  the  blood-vessels,  and  by  condensing  the  tissues 
themselves,  the  members  of  this  group  will  depress  the  vital  action  of  a 
sore,  and  so  check  the  secretion  of  mucus  or  pus.  For  this  purpose  alum 
is  applied  dry,  or  in  solution,  to  relaxed  and  abundantly  secreting  sores. 

In  such  cases  other  astringents  generally  succeed  better. 

Alum  solutions  may  be  applied  to  free- weeping  eczematous  surfaces 
to  check  profuse  discharge,  and  to  bring  the  eruption  into  a  condition 
suited  for  other  remedies.  Like  other  astringents,  alum  is  generally  in- 
sufficient to  heal  ecezma. 

Owing  to  their  property  of  condensing  tissues  and  coagulating  albu- 
men, these  substances  may  be  used  to  control  the  milder  forms  of  bleed- 
ing, and  alum  in  an  emergency  has  the  advantage  of  being  almost  always 
at  hand.  In  severe  haemorrhage  other  treatment  is  of  course  required, 
but  to  check  the  bleeding  of  the  gums,  of  piles,  leech-bites,  or  slight  cuts, 
alum  dusted  on  the  affected  part,  first  wiping  it  dry,  or  applied  in  a  pretty 
strong  solution,  is  generally  sufficient. 


170  ALUM. 

In  opistaxis,  alum  may  be  injected  into  the  nose,  or  may  be  snuffed 
up  as  the  dried  powder. 

In  strong  solutions  (six  grains  to  the  ounce)  alum  has  been  recom- 
mended, though  it  is  little  used,  in  prolapsed  anus  or  uterus. 

In  vulvitis  of  children,  few  remedies  can  be  compared  to  alum  used  in 
the  strength  of  sixty  grains  to  a  pint  of  water,  and  frequently  applied, 
every  hour  or  oftener,  by  the  help  of  a  syringe^  to  the  secreting  surface, 
first  washing  away  the  pus  with  warm  water  and  then  applying  between 
the  parts  a  piece  of  Ihit  soa^ked  in  the  lotion.  Although  generally  success- 
ful, this  treatment  sometimes  fails  to  check  this  troublesome  complaint, 
even  when  it  cannot  be  traced  to  any  irritation,  as  worms,  constipation  or 
teething.  In  some  cases  the  discharge,  besides  comiiig  from  the  surface 
of  the  vulvae,  is  poured  out  from  the  lining  membrane  of  the  vagina, 
when  it  is  necessary  to  take  care  to  pass  the  injection  up  the  vagina. 
Want  of  attention  to  this  fact  explains  the  occasional  failure  of  treatment 
and  ap])arent  obstinacy  of  the  case.  The  solution  just  recommended  may 
sometimes  prove  too  strong,  increasing  both  the  inflammation  and  the 
discharge,  when,  of  course,  its  strength  must  be  reduced. 

Similar  solutions  are  useful  in  chronic  otorrhcea,  but  alum  is  far  in- 
ferior to  glycerine  or  tannic  acid. 

A  solution  of  alum,  of  the  strength  of  eight  grains  to  the  ounce  of 
water,  is  an  excellent  solution  in  simple,  and  especially  in  purulent,  oph- 
thalmia of  children.  The  conjunctiva  must  be  well  washed  with  it  eveiy 
quarter  of  an  hour,  for  success  depends  on  the  frequency  of  the  applica- 
tion. Simple  water,  as  frequently  applied,  is  a  useful,  although  inferior, 
substitute. 

Few  substances  are  as  useful  as  alum  in  certain  diseases  of  the  mouth. 
Thus,  in  simple  ulcerative  stomatitis — that  form  which,  beginning  at  the 
edge  of  the  gums,  and  never  spreading  far  beyond,  is  often  limited  or 
most  marked  over  one-half  of  the  jaw — gives  way  in  a  few  days  to  dried 
alum  applied  with  the  finger  many  times  a  day.  It  is  not  merely  astrin- 
gent; but  from  its  attraction  for  water  (which  it  has  lost  by  being  heated) 
it  is  also  slightly  escharotic,  and  gently  stimulating  to  the  indolent  tissues. 
Ulcers  like  these  produce  ulceration  by  contact  with  the  contiguous 
mucous  membrane  of  the  tongue  or  cheek. 

Aphthous  ulcers,  showing  but  little  disposition  to  heal,  or  indeed, 
tending  to  spread,  may  be  touched  with  dried  alum  a  few  times  a  day  with 
the  best  effect.  Usually,  no  such  application  is  required,  and  chlorate  of 
potash,  and  perhaps  a  purgative,  are  all  that  is  necessary.  Other  forms 
of  ulceration  may  be  treated  in  the  same  Avay,  Alum  is  recommended  to 
be  applied  to  the  throat,  either  dry  or  in  solution,  in  simple  or  scarlatinal 
sore-throat,  in  tonsillitis,  and  even  diphtheria.  Alum  being  now  little 
used  in  any  of  these  cases,  its  advocates',  perhaps,  exaggerated  its  good 
effects. 

It  is  asserted  that  ten  grains  of  powdered  alum,  placed  dry  on  the 
tongue,  will  sometimes  arrest  a  paroxysm  of  asthma. 

Gargles  of  alum  are  more  useful  in  chronic  inflammations  of  the  throat, 
when  the  mucous  membrane  is  relaxed  and  covered  Avith  a  grey  mucus  or 
with  pus;  but  although  alum  is  highly  useful,  tlie  glycerine  of  tannin  is 
a  surer  and  less  disagreeable  application. 

Many  cases  of  chronic  ozaena  speedily  yield  to  a  solution  of  alum,  a 
drachm  to  the  pint,  applied  by  an  irrigating  tube.  About  a  foot  above 
the  patient's  head  is  a  jug  containing  the  solution,  and  in  this  jug  one 


ALUM.  171 

end  of  an  elastic  tube  is  placed.  The  solution  is  then  sucked  or  manipu- 
lated into  the  tube,  when  the  free  end  is  placed  in  one  nostril,  and  the 
ala  of  the  nose  pressed  on  it  to  secure  it  in  position.  Here  we  have  a 
syphon,  and  the  fluid  runs  from  the  vessel  through  the  tube,  up  one 
nostril,  round  the  septum,  and  down  the  other  nostril,  washing  the  sinu- 
osities of  the  nasal  membrane  most  thoroughly.  The  head  is  bent  a  little 
forward,  and  the  mouth  must  be  kept  open,  and,  i'f  properly  managed, 
none  of  the  solution  escapes  by  the  mouth,  or  runs  down  the  throat. 
Even  when  this  irrigation  fails  to  eradicate  the  disease,  it  checks  the  dis- 
charge, and  removes  the  offensive  smell  depending  on  decomposing 
matters.  Some  prefer  acetate  of  alumina  as  more  efficient  in  correcting 
the  fcetor  than  simple  alum.  If  the  foetor  persist,  the  application  should 
be  used  twice  a  day,  or  oftener.  If  the  foetor  is  very  great,  a  weak  solu- 
tion of  j)erma.nganate  of  potash  or  carbolic  acid  may  be  used.  A  wash  of 
a  solution  of  glycerine  of  tannin  in  water  is  often  useful;  also  a  saturated 
solution  of  boracic  acid. 

A  strong  solution  of  alum  is  sometimes  useful  in  pruritus  vulvae. 

Ten  grains  of  alum  to  the  ounce  of  water  is  used  in  the  form  of  spray 
for  chronic  coughs  and  hoarseness. 

Alum  behaves  in  the  stomach  as  on  the  denuded  skin;  it  coagulates 
the  albumen,  and  constringes  the  mucous  membrane;  and  it  hinders  diges- 
tion by  each  of  these  processes.  It  will  often  check  bleeding  from  the 
stomach,  but  it  is  inferior  to  other  astringents.  It  sometimes  controls 
vomiting.  In  six  to  ten-grain  doses  it  sometimes  checks  obstinate  forms 
of  vomiting,  occurring  in  phthisical  patients,  especially  that  form  excited 
by  coughing. 

Dr.  ]\leigs  speaks  very  highly  of  alum  emetics  for  children,  and  he 
prefers  it  to  other  emetics  in  croup.  He  gives  a  drachm  in  honey  or  syrup 
every  ten  or  fifteen  minutes  till  the  child  vomits;  but  a  second  dose  is 
not  generally  required.  Alum,  he  says,  does  not  weaken,  and  does  not 
lose  its  efi'ects  so  soon  as  antimony  or  ipecacuanha,  but  my  experience  by 
no  means  confirms  this  statement.  Dr.  Meigs  strongly  advocates  the  em- 
ployment of  emetics  in  true  croup,  and  thinks  that  many  lives  might  be . 
saved  were  they  more  commonly  used  and  repeated  oftener.  In  severe 
cases,  he  produces  vomiting  three  or  four  times  a  day  or  even  oftener- 
This  treatment  must  be  begun  early. 

Alum  checks  secretion  from  the  mucous  membrane  of  the  intestines, 
and  constipates  by  rendering  the  contents  of  the  canal  more  compact  and 
more  difficult  of  propulsion.  Alum  is  sometimes  usetl  in  both  acute  and 
chronic  diarrhcea,  and  it  has  proved  useful  in  the  diarrhoea  of  typhoid 
fever  and  of  dysentery. 

It  is  uncertain  how  far  the  members  of  this  group  pass  down  the  intes- 
tinal canal,  but  probably  not  far,  without  being  decomposed  and  rendered 
inert.  Alum,  extolled  by  many  high  authorities  in  lead  colic,  is  said  to 
remove  the  spasm  and  the  pain,  and  at  the  same  time  to  unload  the  bowels 
more  speedily  and  certainly  than  other  remedies.  It  is  given  in  consider- 
able quantities,  as  much  as  ten  grains  every  hour.  The  few  trials  I  have 
given  this  treatment  have  not  been  rewarded  with  success. 

The  long-continued  administration  of  these  substances  produces  loss 
of  appetite,  constipation,  and  at  last  chronic  catarrh  of  the  stomach  and 
intestines.  Large  doses  cause  gastro-enteritis  at  once,  with  its  usual 
symptoms. 

When  the  acute  stage  of  whooping-cough  is  over,  and  when  there  is 
no  fever  nor  inflammation  of  the  lungs,  nor  any  irritation  of  the  teeth. 


172  PREPARATIONS    OF    IRON. 

alum  is  an  excellent  remedy.  In  fact,  it  is  useful  only  in  uncomplicated 
cases;  but  in  these,  few  remedies  give  more  satisfactory  results.  It 
speedily  reduces  the  violence  and  frequency  of  the  paroxysms,  often, 
indeed,  at  once  lessening  their  recurrence  one-half,  and,  in  fact,  it  often 
straightway  cures. 

Alum  checks  the  troublesome  vomiting  so  often  met  with  in  whooping- 
cough,  and  much  improves  the  appetite — effects  observed  sometimes  even 
before  the  cough  undergoes  any  diminution.     Constipation  rarely  happens. 

Alum  may  control  whooping-cough  simply  by  its  astringent  action  on 
the  throat,  and  in  support  of  this  conjecture,  other  astringent  substances, 
as  tannin,  etc.,  are  likewise  useful  (see  Tannin),  even  when  applied  to  the 
throat  only.  Alum  itself  acts  best  when  mixed  with  some  tenacious  fluid, 
as  gum,  glycerine,  or  honey,  so  that  the  solution  is  made  to  cling  some 
time  about  the  fauces. 

The  alum  should  be  given  in  doses  varying  from  two  to  six  grains 
every  three  hours,  or  it  may  be  given  hourly  in  corresponding  doses. 
Alum  is  generally  beneficial  in  the  paroxysmal  cough,  which  may  continue 
a  long  time  after  the  characteristic  whoop  has  disappeared,  and  in  other 
coughs  having  the  same  spasmodic  character. 

It  is  unknown  how  much  of  these  substances  is  absorbed  by  the  intes- 
tines, and  conveyed  into  the  blood,  but  probably  not  a  large  quantity. 
The  chief  part  escapes  by  the  fasces,  which  the  alum  is  said  to  make  firmer 
and  odorle'ss. 

Dr.  Justin  finds  that  a  grain  and  a  half  of  sulphate  of  alumina,  one 
grain  of  bismuth,  with  enough  extract  of  gentian  to  form  a  pill,  to  be 
taken  night  and  morning,  is  useful  in  chronic  constipation. 

It  is  doubtful  if  alum  has  much  effect  as  a  remote  astringent  to  check 
bleeding  from  the  lungs,  uterus,  kidneys,  etc.,  and  to  check  profuse 
sweating  and  discharges.  Alum  injections,  one  drachm  to  a  j^int,  employed 
in  the  manner  directed  for  the  injection  of  carbonate  of  soda  (see  Potash 
Group),  are  very  useful  to  check  leucorrhoeal  discharges.  The  alum  solu- 
tion constringes  the  parts,  and  sometimes  causes  severe  cramp-like  pains 
in  the  belly. 


PEEPARATIONS  OF   IRON. 

Ikon  is  a  constant  and  necessary  constituent  of  the  body,  and  must 
be  regarded  as  an  important  food. 

None  of  the  preparations  of  this  metal  applied  to  the  skin  produce  any 
change  in  it.  Several  of  the  soluble  salts  combine  with  albumen  on  raw 
surfaces,  sores,  and  mucous  membrane,  condensing  the  tissues,  and  con- 
stringing  the  blood-vessels;  and,  besides  this  astringent  action,  they  at  the 
same  time  act  as  stimulants  or  irritants,  according  to  the  strength  of  the 
application  or  the  condition  of  the  sore. 

The  organic  salts  are  less  astringent  and  stimulating  than  the  inoi-ganic; 
while  of  the  inorganic,  the  ferric  salts  possess  these  properties  in  a  greater 
degree  than  the  ferrous  salts. 

Several  compounds  of  iron  may  be  employed  as  astringents  and  stimu- 
lants; but,  when  a  stimulant  is  required,  other  metallic  preparations  are 
j)referable.     The  sulphate,  and  especially  the  ferric  chloride,  solid  or  in 


PREPARATIONS    OF    IRON.  1  7o 

solution,  are  employed  to  check  haemorrhage.  The  chloride  is  a  powerful 
styptic,  and  readily  controls  the  hleeding  from  small  vessels,  but  it  has  the 
disadvantage  of  irritating  the  surface  of  wounds,  and  preventing  union  by 
first  intention.  Carbolic  acid  will  probably  supersede  perchloride  of  iron; 
for  this  acid,  properly  employed,  does  not  hinder  the  immediate  closure 
of  a  wound. 

The  soluble  preparations  of  iron  have  a  metallic  astringent  taste,  and 
act  on  the  mucous  membrane  of  the  mouth  as  on  the  abraded  skin. 

Iron  salts  are  never  employed  as  topical  agents  in  diseases  of  the  mouth; 
and,  as  they  often  discolor  the  teeth  and  stain  the  tongue  black,  especially 
when  the  breath  contains  sulphuretted  hydrogen  gas,  arising  from  carioiis 
teeth,  etc.,  they  may  he  taken  through  a  quill,  glass  tube,  or  reed. 
They  are  conveniently  given  in  the  form  of  pill. 

Tincture  of  iron,  painted  over  an  erysipelatous  surface,  is  a  useful 
application.  This  treatment  is  commended  in  the  erysipelas  following 
vaccination. 

Solutions  of  astringent  preparations  of  iron,  as  a  drachm  of  the  solu- 
tion of  the  subsulphate  in  eight  ounces  of  water,  are  recommended  as  a 
sjoray  in  bleeding  from  the  nose  or  lungs,  and  even  insufflation  of  the 
powdered  sulphate  has  been  successfully  employed;  though  one  would 
expect  this 'treatment  would  excite  cough,  and  favor  bleeding.  This 
spray  also  is  useful  in  chronic  oza?na. 

The  effects  of  these  salts  in  the  stomach  differ  according  to  their  prop- 
erties. Some  are  astringent,  stimulating,  and  in  large  doses  irritating  to 
the  mucous  membrane,  as  the  pernitrate,  the  perchloride,  the  iodide,  and 
the  sulphate,  while  the  remaining  preparations  with  respect  to  this  mem- 
brane are  almost  inert.  If  the  stomach  is  irritable,  bland  preparations 
of  iron  must  be  chosen.  It  is  often  stated  that  chlorotic  or  anaemic 
patients  with  Aveak  stomachs  must  be  treated  with  bland  unirritating 
preparations  of  iron.  In  some  instances,  no  doubt,  the  astringent  jtrepa- 
rations  are  unsuited,  but  in  most  cases  they  produce  far  bettor  results 
than  the  bland  forms  of  iron,  A  pale,  flabby,  broad,  and  teeth-indented 
tongue,  indicates  almost  always  the  need  of  large  doses  of  the  astringent 
preparations  of  iron.  Thirty  drops  of  the  tincture,  or  three  or  four 
grains  of  the  sulphate,  may  be  given  three  times  a  day.  Weak  anaemic 
girls,  suffering  from  pain  and  vomiting  after  food,  with  perhaps  tender- 
ness of  the  skin  at  the  epigastrium,  are  often  effectively  treated  by  large 
quantities  of  the  tincture  of  the  perchloride. 

The  soluble  preparations  of  iron  combine  with  the  albumen  in  the 
stomach,  forming  soluble  protosalts,  persalts  and  insoluble  albuminates, 
which,  however,  are  soluble  in  dilute  acids  and  gastric  juice,  while  the 
insoluble  pre])arations  are  dissolved  to  a  variable  extent  in  the  acids  of 
the  gastric  juice.  The  reduced  iron  is  pretty  freely  soluble  in  the  gastric 
juice,  but  gives  off  hydrogen  gas;  or,  if  the  preparation  is  impure  and 
contains  a  sulphide,  sulphuretted  hydrogen,  either  gas  causing  eructa- 
tions, and  the  sulphuretted  hydrogen  a  very  disagreeable  taste.  The  per- 
oxide, if  strongly  heated,  is  soluble  in  the  stomach  with  great  difficulty; 
the  more  slightly  heated  forms  should  therefore  be  preferred.  The  car- 
bonate and  the  magnetic  oxide  are  more  easily  dissolved  than  the  sesqui- 
oxide. 

The  astringent  preparations,  as  the  perchloride,  acetate,  pernitrate 
or  sulphate,  are  employed  to  check  ha?moirhage  from  the  stomach.  In 
proportion  to  their  astringency  these  preparations  confine  the  bowels. 


174  PREPARATIONS    OF    IRON. 

Since  after  quitting  the  stomach  tliey  are  soon  clianged  into  an  insohi- 
ble  and  inert  sulphide,  their  astringency  must  extend  itself  on  the  upper 
part  of  the  small  intestines. 

The  sulphate,  acetate,  perchloride,  pernitrate,  in  common  with  otlier 
astringent  metallic  preparations,  may  he  given  in  diarrhoea.  The  perni- 
trate,  much  praised  in  the  chronic  forms  of  diarrhoea,  is  probably  an  effi- 
cient preparation. 

In  bleeding  from  the  stomach  small  doses  of  the  astringent  prepara- 
tions in  iced  water  should  be  given  hourly. 

Owing  to  the  astringency  of  iron  salts,  it  is  well  to  combine  each  dose 
with  some  laxative,  as  a  quarter  of  a  grain  of  aloes,  a  few  grains  to  half  a 
drachm  of  sulphate  of  magnesia,  soda,  or  potash.  Some  authorities  con- 
sider that  the  combination  of  iron  with  a  laxative  markedly  promotes  the 
absorption  of  the  iron.  Iron  salts,  however,  by  no  means  always  consti- 
pate, and,  indeed,  large  doses  of  the  astringent  preparations,  as  the 
sulphate,  often  relieve  constipation. 

In  their  course  along  the  intestines,  iron  salts,  as  we  have  said,  are 
changed  into  a  sulphide  of  the  metal,  giving  to  the  iivces  a  black  and 
characteristic  appearance.  A  very  small  quantity  of  an  iron  salt  is  suffi- 
cient to  stain  the  motions  deeply,  and  to  keep  them  darkened  for  several 
days  after  its  discontinuance.  Iron  salts  have  no  direct  influence  on  the 
pancreatic  or  biliary  secretions. 

In  the  treatment  of  the  small  thread- worms  infesting  the  rectum,  the 
tincture  or  the  sesquichloride,  in  the  strength  of  a  drachm  of  the  tincture 
to  half  a  pint  of  Avater,  is  an  efficient  injection;  it  coagulates  the  albumen 
and  destroys  the  thread- worms. 

It  is  an  interesting  and  important  question — How  much  iron  is  absorbed 
into  the  blood  ?  Probably  but  little  of  the  insoluble  forms,  as  the  quantity 
of  acid  in  the  stomach  is  not  adequate  to  dissolve  them;  and  as  regards 
the  soluble  preparations  it  is  hard  to  say  how  much  gets  into  the  blood. 
The  increase  of  the  iron  in  the  urine  being  very  slight,  after  administer- 
ing a  soluble  iron  salt,  it  has  been  concluded  that  very  little  passes  into 
the  blood;  and  the  fact  that  almost  all  the  iron  taken  by  the  mouth  may 
be  re-obtained  from  the  fieces,  seems  to  strengthen  this  view;  but  an  ex- 
tended knowledge  concerning  the  elimination  of  metals  from  the  body 
shows  this  conclusion  to  be  fallacious.  Probably  most  metals,  but  cer- 
tainly iron,  are  eliminated  from  the  system  through  the  intestines,  and 
make  their  exit  with  the  faeces;  for,  when  iron  salts  are  injected  into  the 
blood,  almost  all  the  metal  is  ultimately  recoverable  from  the  fa?ces.  That 
much  more  is  absorbed  than  is  appropriated  by  the  blood  corpuscles  is 
shown  by  the  coloration  iron  produces  in  all  the  albuminous  secretions  of 
the  body,  the  fluids  Ijathing  the  various  cavities  becoming  colored  reddish- 
brown.  Still,  the  quantity  absorbed  is  probably  not  very  large,  for  when 
an  iron  salt  is  injected  into  the  blood,  much  of  it  passes  out  by  the  urine. 

Oxide  of  iron  possesses  an  ozonizing  power.  "  Thus,  a  spot  of  iron- 
mould,  i.e.,  iron  oxide,  on  linen,  will  in  time  destroy  the  fabric.  From 
a  similar  cause  a  fleck  of  rust  on  a  bright  surface  of  steel  will  steadily 
enlarge  and  deepen."  (Horatio  Wood.)  Hence  it  is  argued  that  the 
iron  of  the  blood  corpuscles  acts  in  the  same  way,  converting  oxygen 
into  ozone,  thus  promoting  oxidation,  ozone  being  the  active  form  of 
oxygen  in  the  system. 

In  the  treatment  of   ansemia  many  physicians  advocate  the  use  of 


PREPARATIONS    OF    IRON".  175 

large  doses  of  iron  salts;  others,  instancing  the  beneficial  effects  of  fer- 
ruginous waters,  strenuously  maintain  that  all  the  good  effects  are  ob- 
taiualile  from  very  small  doses.  In  many  instances,  no  doubt,  anemia 
is  curable  by  the  employment  of  small  quantities  of  iron,  but  it  is  like- 
wise certain  that  large  quantities,  when  they  can  be  borne,  act  far  more 
jn'omptly.  Half  drachm  doses  of  the  tincture,  or  six  to  eight  grains  of 
the  sulphate,  may  be  given  two  or  three  times  daily.  The  following  j^ill, 
originally  employed  by  Bland,  and  strongly  recommended  by  Niemeyer, 
is  no  doubt  very  efficacious,  but  the  iron  without  the  carbonate  appears 
to  answer  as  well.  Sulphate  of  iron,  carbonate  of  potash,  of  each  half 
an  ounce;  tragacanth,  as  much  as  is  required  to  make  ninety-six  pills; 
three  to  be  taken  three  times  a  day,  an  additional  pill  being  added 
daily. 

A  convenient  pill  is  made  with  five  grains  of  the  dried  sulpliate  of 
iron,  equal  to  about  nine  grains  of  the  ordinary  suljjhate,  with  a  drop  of 
syrup.  This  sets  into  a  firm  pill,  easily  dissolved  in  the  stomach.  A 
small  quantity  of  extract  of  belladonna  may  be  added  to  prevent  consti- 
pation, but  when  given  alone  this  pill  seldom  constipates.  Larger  doses 
of  iron,  while  rarely  upsetting  the  stomach,  or  j^roducing  headache,  often 
cure  anaemia  with  astonishing  rapidity.  This  pill  is  especially  useful  in 
chlorosis,  but  when  this  pill  cannot  be  borne  I  obtain  excellent  results 
by  giving  five  grains  of  the  reduced  iron  three  times  a  day. 

The  experiments  of  Drs.  Cutler  and  Bradford,  conducted  after  Mal- 
assez's  method  of  counting  the  blood  corpuscles,  show  that  in  health  iron 
does  not  increase  the  number  of  blood  corpuscles,  though  it  does  in 
anaemia. 

Iron  salts  are  largely  used  in  ansemia;  they  are  especially  useful  in 
chlorpsis.  Cases  of  ansemia,  apart  from  those  forms  due  to  loss  of  blood 
or  exhausting  organic  diseases,  fall  into  two  classes,  though  both  forms 
may  be  combined.  In  chlorosis,  the  number  of  corpuscles  is  but  little 
reduced,  but  their  haemoglobin  is  very  deficient  in  quality.  In  perni- 
cious anremia,  on  the  other  hand,  the  number  of  corpuscles  is  greatly 
reduced,  but  the  coloring  matter  in  each  is  normal  in  amount.  Iron  is 
chiefly  beneficial  in  chlorosis,  where  haemoglobin  is  deficient  without 
much  diminution  in  the  number  of  corpuscles,  and  is  much  less  service- 
able, and,  indeed,  is  very  often  useless,  in  pernicious  anaemia,  in  which 
serious  condition  arsenic  is  very  useful. 

In  chlorosis  the  production  of  corpuscles  is  but  little  diminished,  but 
they  contain  too  little  coloring  matter.  There  is  also  excess  of  the  larger 
and  especially  of  the  smaller  corpuscles,  the  smaller  being  newly  formed 
and  ill-developed  and  easily  acted  on  by  re-agents.  There  is  indeed  in 
chlorosis  *'  imperfect  evolution  of  blood."  (Wilcocks,  Moriez.)  Iron 
improves  the  condition  of  the  blood  discs,  increasing  their  color  and  less- 
ening the  amount  of  small-sized  discs. 

In  pernicious  anaemia  the  production  of  red  corpuscles  is  reduced,  and 
in  such  cases  iron  has  very  little  influence,  arsenic  being  a  much  more 
potent  remedy;  hence  it  is  argued  that  iron  exerts  little  or  no  influence 
on  the  formation  of  red  corpuscles. 

It  is  true  that  in  chlorosis  the  number  of  red  discs  may  be  somewhat 
reduced,  and  iron  salts  will  then  augment  their  number;  but  it  is  argued 
tliis  is  not  due  to  an  increase  in  the  production  of  discs,  but  to  the  fact 
that  iron  improves  the  vitality  of  the  red  corpuscles  by  increasing  their 


176  PREPARATIONS    OF    IRON. 

hsemoglobin,  and  by  prolonging  the  life  of  the  red  discs  increases  their 
total  number. 

In  many  cases  of  anaemia  the  combination  of  iron  and  arsenic  is  useful. 

Iron  salts  are  also  useful  in  angemia  from  haemorrhage,  and  to  a  much 
less  extent  in  anaemia  dependent  on  organic  disease. 

The  long-continued  use  of  iron  is  highly  beneficial  in  scrofula  and 
rickets. 

Iron-salts  are  commonly  administered  in  amenorrhoea;  as  there  is 
usually  much  anaemia  conjoined  Avith  this  affection,  the  iron,  in  remedy- 
ing the  ana?mia,  assists  in  restoring  the  uterine  functions. 

It  must  be  remembered  that  anaemia  is  dependent,  not  on  deficiency 
in  the  supj^ly  of  iron,  but  on  its  scanty  assimilation;  hence  iron  must 
be  conjoined  with  well-regulated  hygienic  conditions,  otherwise  it  does 
comparatively  little  good. 

In  anaemia  iron  suits  possess  other  important  proj^erties  besides  their 
influence  over  the  growth  of  the  corpuscles.  They  act  bracingly  on  the 
relaxed  mucous  membrane  of  the  digestive  canal  and  probably  in  this 
way  tend  to  restore  its  functions.  Moreover  it  is  highly  probable  that 
after  its  entrance  into  the  blood  the  iron  exerts  an  influence  beyond  that 
of  merely  increasing  the  quantity  of  red  corpuscles;  hence  iron  salts 
are  useful  not  only  as  a  food  to  promote  the  formation  of  blood  discs  and 
so  improving  general  nutrition,  but  likeAvise  on  account  of  their  beneficial 
influence  on  the  tissues.  Iron  therefore  must  be  regarded  as  a  food  as 
well  as  an  important  curative  agent.  When  it  is  desired  to  benefit  toni- 
cally  the  mucous  membrane  of  the  digestive  canal  and  the  tissues,  large 
quantities  of  the  soluble  astringent  preparations  should  be  administered. 

The  exjoerience  of  physicians  of  the  last  generation  accorded  with 
these  views,  and  so  does  that  of  many  highly  practical  men  of  the  present 
day;  but  on  the  introduction  of  the  bland  and  almost  tasteless  prepara- 
tions of  iron,  they  were  assumed  to  be  in  every  way  superior  to  the  as- 
tringent forms.  Their  comparative  tastelessness  is  certainly  in  their 
favor.  It  used  to  be  considered,  mainly  on  speculative  grounds,  that 
the  astringent  preparations  must  disorder  digestion;  and  these  theoreti- 
cal, and  as  I  believe  unfounded,  opinions  still  prevail.  In  a  certain  class 
of  ansmic  patients  the  astringent  jareparations,  even  in  large  doses,  are 
preferable,  and  a  large  share  of  their  efficacy  is  due  to  their  direct  action 
on  the  mucous  membrane  of  the  stomach  and  intestines,  and  on  the 
organs  Avhich  stud  them.  It  has  been  experimentally  shown  that  sul- 
phate of  iron  does  not  check  the  solvent  action  of  the  gastric  juice,  and 
experience  justifies  the  conclusion  that  in  weak  anaemic  patients  it  does 
not  lessen,  but  rather  increases  the  formation  of  this  secretion. 

If  the  digestive  mucous  membrane  is  in  an  irritable  state,  then,  as 
has  been  previousl}^  pointed  out,  the  astringent  iron  preparations,  in  full 
doses,  may  do  harm. 

Individual  peculiarities  must  be  taken  into  account.  Some  persons 
cannot  take  iron  in  any  form,  not  even  a  single  dose  of  a  weak  ferru- 
ginous water.  Iron  upsets  the  digestive  organs  of  some  patients,  or  it 
induces  fulness  and  pain  in  the  head;  others  again  take  it  not  only  with- 
out inconvenience,  but  Avitli  great  benefit. 

It  is  sometimes  advisable  to  humor  the  stomach  by  occasionally  chang- 
ing the  preparation  of  iron. 

In  a  case  of  neuralgia  with  anjfiifiia  Avhen  no  organic  cause  can  be  dis- 
covered, salts  of  iron  are  especially  recommended,  although  it  is   true 


PREPARATIONS    OF    IRON  177 

their  action  is  uncertain.  The  huge  doses  of  these  salts  sometimes  given, 
especially  of  the  sesquioxide,  are  probably  injurious,  and  are  less  service- 
able than  smaller  ones. 

Large  doses  of  perchloride  of  iron  are  of  great  benefit  in  diiDhtheria. 
Better  use  the  solution  rather  than  the  tincture,  and  to  give  the  medi- 
cine very  frequently — every  hour,  or  even  oftener.  It  is  uncertain 
whether  the  effect  on  the  throat  depends  on  the  topical  action  of  the 
medicine,  or  after  its  entrance  into  the  blood.  The  solution  should  be 
frequently  painted  on  the  throat,  taking  great  jDains  to  apply  it  very 
gently,  lest  by  increasing  the  inflammation  it  may  do  more  harm  than 
good;  this  process  appears  to  arrest  the  spread  of  the  disease,  and  it  is 
said  to  maintain  the  patient's  strength.  The  solution  may  be  applied 
with  the  atomizer,  so  as  to  penetrate  into  the  trachea  and  bronchial  tubes. 
Large  hourly  doses  of  perchloride  have  been  found  of  great  use  in  ery- 
sipelas, though  with  some  observers  this  treatment  has  altogether  failed, 
a  result  perhaps  due  to  the  long  intervals  between  the  doses.  The  fre- 
quent  repetition  of  the  medicine  is  one  of  the  most  necessary  conditions 
of  success. 

In  the  so- culled  hysteria  of  middle-aged  women,  occurring  especially 
at  the  cessation  of  menstruation,  they  often  experience  distressing  flut- 
tering of  the  heart,  a  sensation  of  fulness  of  the  head,  with  heat  and 
weight  on  the  vertex,  frequent  flushings  of  the  face,  and  "  hot  and  cold 
perspiration."  This  combination  of  symptoms  is  generally  removed  by 
considerable  doses  of  the  sesquichloride  of  iron,  given  three  times  a  day. 
If  the  symptoms  are  limited  to  the  head  and  face,  other  remedies  are 
more  successful,  as  nux  vomica,  opium,  belladonna,  bromide  of  potas- 
sium, nitrite  of  amyl. 

Salts  of  iron  sometimes  excite  irritation  of  the  bladder,  witli  frequent 
desire  to  pass  water,  wliich  may  contain  a  considerable  quantity  of  mucus. 
With  children  they  may  cause  nocturnal  incontinence  of  urine,  yet  iron 
salts  not  unfrequently  cure  this  troublesome  complaint,  even  when  not 
dependent  on  worms  in  the  rectum,  or  other  irritation.  Astringent 
preparations  of  iron  contract  somewhat  the  blood-vessels,  and  are  em- 
ployed to  arrest  hsemorrhages  from  the  lungs  and  kidneys. 

Salts  of  iron  appear  to  lessen  profuse  secretions,  such  as  occur  in 
chronic  bronchitis  and  leucorrhoea.  Dr.  Graves  gave  the  compound 
iron  mixture,  in  doses  of  one  or  two  fluid  drachms,  to  check  excessive 
bronchial  secretion. 

The  iodide  of  iron  may  be  given  where  both  iron  and  iodide  are  indi- 
cated, for  instance,  in  syphilis  complicated  with  angemia.  It  is  a  ques- 
tion of  much  interest  whether  it  is  better  to  administer  these  two  agents 
separately  or  combined  in  the  iodide  of  ^iron,  and  whether  the  constit- 
uents continue  in  combination  in  their  course  through  the  stomach  and 
circulation,  or  whether  the  salt  is  decomposed.  Viewing  this  question 
simply  from  a  chemical  point  of  view,  it  would  seem  that  an  iodide  of 
sodium  and  albuminate  of  iron  must  be  formed  in  the  stomach  or  blood, 
though  some  observations,  made  I  believe  by  Bernard,  throw  much 
doubt  on  this  conclusion ;  for  it  was  found  that  if  iodide  of  iiotassium 
and  a  salt  of  iron  were  injected  into  the  blood,  no  iron  appeared  in  the 
saliva,  but  when  an  iodide  of  iron  was  injected,  then  both  iodine  and 
iron  were  found  in  this  secretion. 

The  iron  of  the  effete  red  corpuscles  probably  escapes  with  the  bile, 
and  when  iron  salts  are  swallowed  this  fluid  contains  an  excess  of  the 
12 


178  SALTS    OF   MANGANESE. 

metal.  This,  therefore,  is  one  way  by  which  iron  may  be  separated  from 
the  body.  To  Dr.  Barnes  Ave  are  indebted  for  having  suggested  thu 
injection  of  perchloride  of  iron  into  the  uterus  in  grave  cases  of  flood- 
ing after  deliver}'.  In  such  cases,  obstetricians  are  well-nigh  agreed 
that  this  procedure  is  effective  and  life-saving.  Dr.  Barnes  recom- 
mends four  ounces  of  the  liquor  ferriperchloridi  mixed  with  twelve  of 
water,  to  be  slowly  injected  into  the  uterus  with  a  Higginson's  syringe, 
furnished  with  a  long  uterine  tube,  taking  care  to  avoid  the  introduc- 
tion of  air.and  to  allow  a  free  outlet  of  the  fluid. 

In  chronic  uterine  catarrh  with  clear  white-of-egg-looking  discharge 
issuing  from  a  patulous  uterus.  Dr.  Lloyd  Koberts  recommends  swab- 
bing the  interior  of  the  organ  with  a  solution  composed  of  one  part  of 
perchloride  of  iron  to  four  of  water;  or  the  injicction  of  a  few  drops  of 
the  solution. 

The  tincture  of  the  perchloride  of  iron,  in  the  proportion  of  half  a 
drachm  to  half  a  pint  of  water,  with  a  drachm  of  laudanum,  makes  a 
caj^ital  injection  for  gonorrhoea  or  gleet,  often  speedily  checking  the 
discharge,  and  easing  the  pain  on  micturition.  The  following  injection 
is  useful : — Sulphate  of  iron  twelve  grains,  tincture  of  opium  half  an 
ounce ;  water  eight  ounces,  use  three  times  a  day. 

The  syrup  of  the  phosphate  of  iron  is  a  good  form,  if  there  are  any 
indications  for  the  employment  of  phosphoric  acid.  (See  Phosijhate  of 
Lime.) 

A  teaspoonful  of  lemon-juice  covers  the  taste  of  iron  preparations 
and  tincture  of  steel. 

Milk,  too,  covers  the  styptic  taste  of  iron. 

Iron  salts  to  act  as  food  should  be  administered  soon  after  a  meal. 


SALTS   OF   MAXGANESE. 

The  sulphate  of  manganese  in  large  doses,  acting  on  the  mucous 
membrane  of  the  stomach,  excites  vomiting  and  purging.  It  is  said  to 
increase  the  flow  of  bile,  but  Rutherford  says  it  is  a  powerful  irritant  to 
the  mucous  membrane,  but  not  a  cholagogue.  Manganese  is  generally, 
and  according  to  some  investigators  always,  found  in  the  blood  corpus- 
cles, and  has  come  to  be  regarded  as  a  normal  constituent  of  the  red 
discs,  which  has  led  to  the  administration  of  its  salts  in  ana?mia,  though, 
in  the  hands  of  trustAVorthy  observers,  without  any  benefit. 

Leared  gave  ten  to  fifteen  grain  doses  of  the  black  oxide  in  gastrody- 
nia  and  pyrosis.  Manganese  salts  long  persisted  in  produce,  according 
to  BartholoAv,  wasting,  feebleness,  staggering  and  paraplegia.  They  are 
said  to  cause  acute  fatty  degeneration  of  the  liver. 

The  permanganate  is  a  powerful  oxidizer,  yielding  ozone,  and  is 
widely  used  as  a  disinfectant  and  deodorizer. 

Bartholow  recommends  this  preparation  in  dyspepsia  with  flatulence, 
and  to  assist  the  conversion  of  uric  acid  into  urea.  It  has  been  given 
internally  in  scarlet  fever,  diphtheria,  erysipelas,  puerperal  fever,  and 


SALTS    OF    MANGANESE.  179 

pyaemia;  but  the  permanganate  can  act  only  on  the  mucous  membranes 
with  which  it  comes  in  contact,  and  must  be  decomposed  in  the  stomach. 

Kobert  finds  manganese  salts  are  more  poisonous  to  frogs  than  salts 
of  cobalt,  iron,  nickel  or  tin.  Small  doses  susjjend  voluntary  motion, 
larger  doses  slow  the  reflexes,  and  render  the  heart  weak;  still  larger 
doses  arrest  the  heart  in  systole,  but  the  excitability  of  the  nerves  and 
muscles  by  direct  stimulation  lasts  for  hours. 

In  cases  of  deficient,  delayed  or  arrested  menstruation  I  find  perman- 
ganate of  potash  very  efficacious. 

Otlier  salts  of  manganese  would,  in  all  probability,  act  equally  well, 
but  I  have  not  yet  had  time  to  test  their  action.  The  permanganate 
itself  cannot  pass  into  the  blood  undecomposed. 

The  permanganate  is  useful  in  amenorrhoea  of  young  women.  It  will 
restore  menstruation  after  the  lapse  of  two  years  or  longer;  sometimes 
it  restores  the  discharge  in  a  few  days,  or  the  succeeding  period  may  be 
missed  till  the  next  period  is  due,  or  sometimes  six  weeks  or  iven  two 
months  will  elapse  before  the  drug  succeeds. 

I  find  this  salt  useful  also  in  the  very  common  case  of  scanty,  perhaps 
delayed,  menstrual  flux,  the  interval  varying  from  six  weeks  to  two 
months.  The  permanganate  in  a  case  like  this  brings  on  the  period  at 
its  proper  time,  with  increase  in  the  quantity. 

It  is  useful,  too,  when  a  chill  prevents  or  delays  the  menstrual  flow. 

A  woman  prevented  menstruation  by  taking  a  cold  bath  on  the  day 
it  should  have  appeared,  and  she  suffered  from  the  usual  symptoms  aris- 
ing from  arrest  of  the  catamenia.  Three  doses  of  permanganate  restored 
the  flux.  On  its  appearance  she  discontinued  the  drug,  when  tke  dis- 
charge ceased.  She  returned  to  the  medicine,  and  after  another  three 
doses  the  flow  reappeared  and  progressed  naturally. 

I  find  it  successful  in  cases  of  anaemia,  and  in  plethoric  patients.  It 
certainly  does  not  act  by  improving  the  quality  of  the  blood. 

I  usually 'give  the  salt  daily  till  the  catamenia  appear,  and  then  dis- 
continue; but  I  recommence  it  four  days  before  the  access  of  the  next 
period  and  continue  it  till  the  flow  ceases. 

Dr.  Fordyce  Barker  found  j^ermanganate  useful  in  girls  who  suffer 
from  arrested  menstruation  on  leaving  the  country  and  coming  to  town 
for  their  education;  also  in  amenorrhoea  induced  by  sea  sickness;  and 
with  women,  between  thirty  and  forty,  generally  married,  who  rapidly 
increase  in  weight  while  menstruation  decreases. 

Dr.  Murrill  and  I  in  our  investigations  did  not  find  that  permanga- 
nate produced  abortion,  but  some  cases  of  abortion  apparently  due  to 
the  drug  have  been  published. 

At  first  I  gave  the  solution  of  permanganate  from  3  ss.  to  3  j,  thrice 
daily,  but  the  disagreeable  taste  often  provoked  nausea  and  vomiting, 
especially  after  taking  it  for  some  time.  I  now  give  one,  two  or  more 
grains  in  pill  form  thrice  daily.  Mr.  Martindale  makes  the  pills  accord- 
ing to  the  following  formula: — Permanganate  of  potash  gr.  1,  kaolin  and 
petroleum  cerate  in  equal  parts  q.  s. 


180  BISMUTH. 


NITRATE   OF  BISMUTH,   CARBONATE  OF  BISMUTH. 

These  powders  are  commonly  used  as  harmless  cosmetics;  they  are 
useful  in  intertrigo,  and  sometimes  in  eczema,  as  dusting  jJOAvder;  but 
in  eczema  other  remedies  are  to  be  preferred. 

Applied  to  the  broken  or  unbroken  skin,  these  substances,  being  in- 
soluble in  any  fluid  they  may  then  meet  with,  are  not  absorbed. 

Trousseau  employed  equal  parts  of  bismuth  and  Venetian  calc  in 
chronic  non-syphilitic  ozaena,  ordering  the  j)atient,  after  clearing  the 
nasal  passages  by  strongly  blowing  the  nose,  to  snufl!  up  some  of  this 
powder.     He,  however,  prefers  mercurial  powders.     (See  Mercury.) 

Being  insoluble,  they  are  tasteless,  but  they  sometimes  occasion  a  dis- 
agreeable sensation  of  roughness,  and  sometimes  blacken  the  tongue. 
This  rough  taste  may  be  covered  in  a  great  degree  by  administering  the 
drug  in  milk. 

Little  is  known  at  present  of  the  changes  these  medicines  undergo, 
and  of  their  behavior  in  the  stomach.  Whether  they  are  dissolved  or 
not,  or  whether  their  efficacy  depends  on  physical  or  chemical  j^roperties, 
are  questions  yet  unsolved. 

In  many  diseases  of  the  stomach,  these  preparations,  especially  the 
nitrate,  are  very  valuable,  easing  the  pain  incident  to  many  affections  of 
this  organ,  whether  depending  on  organic  or  so-called  functional  disease. 
In  cancer,  chronic  ulcers,  and  chronic  inflammation  of  the  stomach,  bis 
muth  is  often  serviceable,  and  is  especially  useful  in  the  chronic  gastritis 
of  drunkards,  subduing  the  pain,  checking  the  vomiting,  and  enabling 
the  stomach  to  tolerate  food.  It  is  also  useful  in  gastrodynia  and 
cramp  of  the  stomach.  Many  forms  of  vomiting  in  children,  and  notably 
that  kind  depending  on  acute  or  chronic  catarrh  of  the  stomach,  yield 
speedily  to  bismuth.  The  various  forms  of  pyrosis,  whether  acid,  alka- 
line, or  neutral,  are  very  amenable  to  this  drug,  although  our  limited 
knowledge  concerning  the  causes  of  this  form  of  indigestion  fails  to  en- 
able us  to  lay  down  precise  rules  respecting  the  particular  form  of  it 
most  benefited  by  bismuth. 

Dr.  Graves  treated  acidity  of  the  stomach  witli  nitrate  of  bismuth, 
and  experience  confirms  his  practice.  He  generally  mixed  it  with  opium 
or  morphia,  and  sometimes  with  magnesia.  Flatulent  dyspepsia,  in 
some  of  its  forms,  yields  more  or  less  to  bismuth;  and  it  is  well  some- 
times to  mix  it  with  an  equal  quantity  of  vegetable  charcoal. 

These  remedies  often  succeed  in  some  forms  of  chronic  diarrhoea, 
especially  Avhen  other  drugs  fail,  in  the  exhausting  purging  of  phthisis. 
It  is  necessary  to  give  as  much  as  half  a  drachm  to  a  drachm  of  the  ni- 
trate several  times  a  day,  and  this  large  quantity,  taken  with  milk,  does 
not  disturb  the  stomach.  It  often  subdues  intractable  diarrhoea,  effect- 
ing occasionally  so  great  an  improvement  in  the  general  health  that 
l^atients  whose  speedy  death  seemed  inevitable  rally  and  recover. 

In  the  various  forms  of  diarrhoea  peculiar  to  young  children,  bis- 
muth, in  large  doses,  is  freely  used  on  the  continent.  A  dose  of  thirty 
to  sixty  grains  hourly  is  recommended,  milk  being  at  the  same  time 
withheld.  Much  smaller  doses,  however,  are  often  useful,  and  may  be 
given  with  milk:  a  grain  hourly  is  very  efficacious,  niul  tlie  addition  of 
a  sixth  of  a  grain  of  grey  powder  often  enhances  its  efficacy. 


LEAD   SALTS.  181 

Bismuth  preparations  are  not  employed  to  act  on  the  remote  organs 
of  the  body. 

Large  doses  of  sohible  ^^reparations,  as  the  citrate  of  bismutli  and 
ammonia,  act  much  like  antimony  or  arsenic,  causing  gastro-enteritis 
and  fatty  degeneration  of  the  liver  (Brunton). 

A  bismuth  injection,  consisting  of  bismuth  half  an  ounce,  glycerine 
half  an  ounce,  water  three  ounces,  is  very  useful  in  gonorrhoea,  especially 
iu  its  chronic  state,  and  sometimes  proves  serviceable  in  gleet. 

The  chief  part,  if  not  all  the  bismuth  swallowed,  is  evacuated  with 
the  faces,  and  stains  the  motions  a  dark  slate  color.  A  portion,  indeed, 
may  be  absorbed,  but  the  quantity  entering  the  blood  is  probably  ex- 
tremely small. 

Hans  Meyer  finds  bismuth  salts  are  eliminated  by  the  mucous  mem- 
brane of  the  intestine,  especially  of  the  large  intestine,  for  after  subcuta- 
neous or  intravenous  injection  of  a  bismuth  salt,  the  mucous  membrane 
becomes  blackened,  and  bismuth  can  be  detected.  Sometimes  the  mucous 
membrane  of  the  intestine  was  found  ulcerated,  Meyer  suggests,  from 
blocking  of  the  arteries  by  sulphide  of  bismuth. 


LEAD   SALTS. 


Lead  added  to  albuminous  fluids,  forms  a  precipitate  composed  of 
albuminate  of  lead.  Like  other  metals,  the  soluble  salts  of  this  group, 
when  applied  to  the  abraded  skin,  or  to  sores,  or  to  mucous  membranes, 
coat  them  with  an  impermeable  air-proof  covering;  if,  however,  a  pro- 
tecting covering  is  required,  other  metallic  salts  are  generally  employed. 
Any  excess  of  lead  solution,  after  combination  with  the  albuminous  part 
of  the  secretion,  will  unite  with  the  tissues  themselves,  in  which  manner, 
probably,  lead  salts  condense  these  structures,  and  constringe  the  blood- 
vessels. The  soluble  lead  salts  are  used  as  lotions  to  unhealthy  and  over- 
secreting  sores,  and  to  eczematous  eruptions;  lead  lotions  in  some  forms 
of  eczema  being  very  useful.  When  there  is  much  inflammation,  and 
when  the  surface  is  raw  and  weeps  copiously,  a  lead  lotion  allays  inflam- 
mation, checks  the  discharge,  and  quells  the  itching,  burning,  and  ting- 
ling so  often  accompanying  eczema.  Two  or  three  drachms  of  liquor 
plumbi  in  ten  ounces  of  water  are  generally  sufficient;  but  a  stronger 
lotion,  consisting  of  two  ounces  of  liquor  plumbi,  two  ounces  of  glycer- 
ine, and  four  ounces  of  water,  is  sometimes  more  successful.  When  the 
inflammation  is  great,  and  the  weeping  abundant,  the  rash  must  be  con- 
stantly covered  with  rags  soaked  in  the  lotion.  In  some  cases  it  is  use- 
ful to  apply  a  poultice  at  night,  and  the  lotion  during  the  day.  The 
stronger  lotion  is  especially  useful  in  difi'used  eczema,  without  weeping, 
but  with  excessive  itching  and  tingling,  and  the  diseased  skin  should  be 
sponged  with  the  lotion  several  times  a  day.  A  weak  alkaline,  or  a  sul- 
phur bath,  greatly  assists  the  action  of  the  lotion.  The  fluid  oozing  so 
abundantly  in  eczema  being  strongly  alkaline,  the  property  of  these 
lotions  to  check  this  discharge  may  be  owing  to  their  weak  alkaline  reac- 
tion {vide  the  Chapter  on  the  Topical  Influence  of  Acids  and  Alkalies  on 


182  LEAD   SALTS. 

the  Secretions).  The  stronger  lotion  very  effectually  allays  the  itching 
of  pityriasis.     Lead  lotions  occasionally  ease  the  itching  of  urticaria. 

A  lead  lotion  is  often  of  great  service  in  pruritus  pudendi,  especially 
when  the  mucous  membrane  is  red  and  excoriated.  A  weak  lotion 
sometimes  fails  where  a  strong  one  succeeds.  It  may  be  necessary  to 
use  equal  parts  of  liquor  plumbi  and  glycerine,  on  application  which 
may  excite  a  little  very  temporary  smarting.  AVhen  pruritus  pudendi 
depends  on  ascarides,  haemorrhoids,  or  a  tumor  in  the  urethral  passage, 
it  is  obvious  that  these  applications  are  useless. 

A  lotion  of  one  part  of  liquor  plumbi,^  with  one  or  two  parts  of  glyc- 
erine, applied  warm  after  the  crusts  have  been  entirely  removed,  is  use- 
ful in  the  milder  forms  of  lupus. 

While  lead  salts  have  many  properties  in  common  with  those  of 
other  metals,  they  are  distinguished  by  their  unirritating,  soothing 
character,  whence  they  are  used  only  as  astringent  and  calming  appli- 
cations. The  soluble  lead  j)re])arations  may  be  used  to  check  bleeding 
from  small  vessels;  but  other  astringents  are  more  effective. 

Solutions  of  the  acetate  and  diacetate  are  employed  as  injections  and 
washes  in  chronic  otorrhoea  and  vulvitis  of  cliildren.  They  lessen  the 
production  of  pus,  and  ease  pain,  by  virtue  of  their  astringency  and  their 
soothing  qualities.  They  are  of  most  use  when  the  acute  stage  has  just 
subsided,  the  tissues  remaining  irritable  and  painful.  In  the  later 
stages  stronger  astringents  are  needed. 

Bland,  unirritating  plasters  made  of  lead  are  in  common  use. 

These  j^lasters  and  lead  applications  generally,  are  sometimes  objec- 
tionable, owing  to  the  black  discoloration  they  produce  from  the  forma- 
tion of  the  black  sulphide,  with  the  sulphuretted  hydrogen  gas  evolved 
by  the  decomposition  of  the  discharges. 

A  stout  plaster  often  relieves  pain  in  the  loins,  due  to  weakness. 

Burgundy  ])itch  on  leather  is  generally  used,  but  it  is  very  liable  to 
produce  a  crop  of  itching  papules,  which  may  spread  over  the  greater 
part  of  the  body,  while  lead  plaster,  though  somewhat  less  adhesive,  is 
comparatively  free  from  this  objection.  Plasters  sometimes  relieve  back 
pains  due  to  uterine  disease  or  piles. 

For  sweating  feet,  Hebra  employs  an  ointment  composed  of  equal 
parts  of  lead  plaster  and  linseed  oil  spread  on  linen,  and  wrapped  round 
the  feet,  renewing  the  application  every  third  day  for  nine  days. 

The  same  ointment  applied  on  soft  linen  twice  daily  is  sometimes 
invaluable  in  the  subacute  stage  of  eczema.  Dr.  Matthews  kindly  draws 
my  attention  to  the  fact  that  this  ointment  must  be  used  fresh  since  it 
becomes  rancid  in  a  few  days. 

In  ulceration  and  sloughing  of  the  cornea,  lead  washes  must  be 
avoided,  lest  a  white  compound  become  deposited  in  the  structures  of 
the  ulcer,  leaving  a  permanent  opacity. 

Mr.  Alfred  Aspland  recommends  the  local  aj^plication  of  white  paint 
for  burns.     He  claims  that  it  relieves  pain  in  two  minutes. 

Lead  injections  are  sometimes  employed  in  gonorrhoea,  gleet,  and 
leucorrhoea. 

Insoluble  lead  salts  are  tasteless;  the  soluble  have  a  sweetish  acid 
and  astringent  taste. 

The  soluble  preparations  are  astringent  to  the  mucous  membrane  of 

'When  liquor  plumbi  is  mentioned  we  refer  to  the  strong'  solution. 


LEAD    SALTS.  183 

the  mouth,  and  combine  with  the  albuminous  substances  they  meet 
with  tliere. 

Tliat  portion  of  the  soluble  compounds  of  lead  which  escapes  com- 
bination with  albumen  in  the  mouth  is  converted  into  an  albuminate  in 
the  stomach. 

The  soluble  lead  preparations  are  sometimes  used  in  htematemesis, 
and  have  been  recommended  to  check  jiyrosis. 

Albuminate  of  lead  in  the  intestines  is  probably  speedily  decomposed 
into  a  sulphide  of  lead,  an  insoluble  an^l  inert  compound.  The  soluble 
salts  act  powerfully  as  astringents  of  the  intestines,  and  cause  constipa- 
tion ;  they  control  many  forms  of  diarrhoea,  even  that  dependent  on 
disease  of  the  lower  part  of  the  small  or  even  of  the  large  intestine. 

The  effects  of  lead  on  the  parts  of  the  intestines  distant  from  the 
stomach  and  duodenum,  can  be  manifested  only  through  the  nervous 
system  or  blood;  and  we  know  the  intimate  sympathy  existing  between 
the  different  parts  of  this  canal. 

In  summer  diarrhoea,  a  few  grains  of  the  acetate  with  a  small  dose 
of  morphia  is  a  sure  and  speedy  remedy. 

The  acetate  has  been  recommended  in  cholera,  especially  in  its  early 
stages.  In  the  purging  from  dysentery  and  typhoid  fever,  and  from 
tubercular  disease  of  the  intestines,  few  remedies  are  so  useful.  The 
acetate  should  then  be  combined  with  opium. 

It  increases  the  efficacy  of  a  starch  injection,  used  to  check  various 
forms  of  diarrhoea;  and  it  may  be  used  for  similar  purpose  as  a  sup- 
pository. 

In  large  doses,  the  acetate  acts  as  a  weak  irritant  poison,  bat  the 
symptoms  it  produces  differ  from  those  of  other  irritants,  chiefly  by 
constipating  instead  of  purging. 

It  is  by  no  means  common  to  meet  with  a  case  of  acute  poisoning 
with  lead  salts,  and  even  the  most  soluble  salts  rarely  cause  death. 

Acute  poisoning  by  the  acetate  induces  the  following  symptoms : — 
Dry  burning  sensation  in  the  throat,  thirst,  vomiting,  colic  (the  pain 
of  which  is  generally  relieved  by  firm  pressure),  tenderness  of  the  abdo- 
men, obstinate  constipation,  dark  slate-color  motions  from  the  presence 
of  plumbic  sulphide,  great  prostration  of  strength,  cramps  of  the  ex- 
tremities, cold  sweats,  giddiness,  numbness  and  even  paralysis  of  the 
lower  limbs;  sometimes  coma;  and  high-colored  scanty  urine.  In  one 
case  it  is  reported  that  in  less  than  five  hours  the  extensor  muscles  of 
the  extremities  became  paralyzed,  and  the  flexors  rigidly  contracted. 
The  sub-acetate  is  even  more  powerful  than  the  acetate.  The  carbonate 
has  no  irritant  action. 

The  treatment  of  acute  poisoning  is  to  promote  vomiting  by  luke- 
warm drinks,  to  give  sulphate  of  soda,  or  sulphate  of  magnesia,  or  fresh 
precipitated  sulphide  of  iron,  which  is  rarely  at  hand;  the  stomach- 
pump  should  be  used,  and  milk,  with  white  of  egg,  may  be  given  with 
advantage. 

Small,  nay,  even  minute  quantities,  taken  for  a  long  time,  will  pro- 
duce chronic  lead  poisoning,  which  may  happen  in  various  ways,  owing 
to  the  manifold  uses  of  lead  compounds.  Oxide  of  lead  is  used  to 
sweeten  wines,  the  soluble  salts  are  used  as  hair-dyes,  and  wafers  are 
often  colored  with  red  lead.  In  grinding  the  carbonate,  the  basis  of  all 
paints,  unless  great  care  is  taken,  the  liner  particles  are  inhaled.  Snuff 
is  sometimes  adulterated  with  lead,  and  sufficient  may  be  snuffed  into 


184  LEAD   SALTS. 

the  system  to  produce  chronic  poisoning.  Dr.  Garrod  has  lately  narrated 
an  instructive  case  of  chronic  lead  poisoning,  through  the  decomposition 
of  the  leaden  envelope  of  a  packet  of  snuff.  Painters  become  poisoned 
by  eating  their  meals  with  unwashed  hands,  and  so  introducing  lead 
into  the  system.  Drinking-water  sometimes  becomes  contaminated  with 
lead  dissolved  from  the  lining  of  tanks.  Certain  conditions  of  the  water 
either  favor  or  retard  the  solution  of  lead.  Thus,  pure  water,  and  waters 
containing  carbonic  acid,  carbonate  of  lime,  and  sulphate  of  lime,  act 
but  little  on  lead.  But,  on  the  other  hand,  waters  containing  much  ox}'- 
gen,  organic  matters,  nitrites,  nitrates,  and  chlorides,  act  freely  on  this 
metal.  Carbonic  acid  is  very  protective  of  lead ;  it  crusts  the  metal  with 
an  insoluble  covering  of  carbonate,  and  protects  it  from  the  further 
action  of  the  water. 

A  very  small  quantity  of  lead  in  water  is  adequate  to  produce  all  or 
some  of  the  symptoms  of  lead  poisoning;  even  one-fortieth  to  one-fif- 
tieth of  a  grain  per  gallon.  But  there  aj)pear  to  be  individual  differences 
in  respect  to  the  action  of  lead,  some  persons  becoming  sooner  affected 
by  it  than  others:  differences  sometimes  susceptible  of  explanation,  as 
will  be  shortly  shown.  Acetate  of  lead,  in  five  grain  doses,  may  be  given 
for  weeks  or  even  months,  without  inducing  lead  poisoning,  as  has  been 
abundantly  proved  at  the  Brompton  Hospital,  where  the  acetate  is  largely 
employed  to  check  the  diarrhea  of  consumption;  yet  it  is  extremely 
rare  to  meet  with  any  lead  symj^toms,  even  after  the  medicine  has  been 
continued  for  months. 

Cosmetics  and  hair-dyes  containing  lead  may  cause  chronic  j^oisoning. 

The  .symptoms  indicative  of  chronic  lead  poisoning  are  briefly — con- 
stipation, and,  it  may  be,  imiDaired  digestion,  accompanied  with  a 
sweetish  taste.  A  blue  line  is  soon  observed  at  the  edges  of  the  gums, 
produced  by  the  suljihuretted  hyrdogen  developed  from  the  tartar  of  the 
teeth  penetrating  the  tissues  of  the  gums  and  uniting  with  the  lead, 
forming  a  black  sulphide,  consequently  the  blue  line  is  most  marked 
in  persons  who  do  not  clean  their  teeth.  It  is  seen  only  at  the  edge  of 
the  gums,  where  they  come  in  contact  with  the  teeth;  where  the  teeth 
are  absent,  the  blue  line  is  absent.  It  is  first  observed,  and  is  always 
most  marked,  in  the  gums  in  the  neighborhood  of  the  incisors.  This 
blue  line  is  one  of  the  earliest  indications  of  the  effect  of  lead,  and  is  one 
of  the  slowest  to  disappear.  Dr.  Garrod  says  this  blue  line  is  never  ab- 
sent if  there  are  any  teeth,  and  that  it  may  extend  to  the  whole  gums, 
and  sometimes  it  is  observed  on  the  j^arts  of  the  lips  and  cheeks  corre- 
sponding to  the  gums.  More  recent  observers  have  seen  cases  without  a 
blue  line.  The  nutrition  is  impaired,  the  skin  becomes  very  sallow,  and 
sooner  or  later  severe  colic,  with  obstinate  constipation  and  sometimes 
vomiting,  sets  in.  Colic  may  occur  without  any  premonitory  signs.  In 
lead  colic  the  abdominal  walls  are  retracted,  and  very  rigid.  The  pain, 
as  in  acute  lead  poisoning,  is  mostly  eased,  though  it  is  sometimes  aggra- 
vated, by  firm  pressure.  The  pulse  is  small  and  incompressible  (high 
tension). 

Frequent  and  often  severe  cramps  occur  in  the  calves,  sometimes  in 
the  uterus,  penis,  and  scrotum;  and  sometimes  the  patient  is  harassed 
with  pains  about  the  joints,  generally  of  the  extremities,  increased  by 
movement  or  wet  weather,  and  closely  simulating  rheunuitic  })ains. 

Sometimes  paralysis  takes  place,  generally  affecting  the  extensors  of 
the  forearm. 


LEAD    SALTS.  185 

The  muscles  first  affected  are  those  supplied  by  the  musculo-spiral  nerves  (pos- 
terior inteix)ssens)  in  the  forearm,  and  especially  the  extensor  communis  digitorum. 
The  supinator  longus  therefore  escapes.  The  supinator  longus  is  almost  always 
supplied  by  a  branch  from  the  musculo-spu'al  nerve  before  it  divides  into  the 
posterior  interosseus  and  radial  nerve.  This  fact  often  enables  us  at  once  to  dis- 
criminate between  lead-poisoning,  and  paralysis  from  disease  of  the  musculo- 
.si)iral  nerve.  If  the  supinator  longus  is  paralyzed,  this  fact  points  to  the  disease 
of  the  musculo-spiral  nerve,  and  then  the  paralysis  is  not  due  to  lead.  If  this 
muscle  is  not  paralyzed,  this  fact  shows  that  the  disease  is  limited  to  the  posterior 
interosseus,  and  that  the  paralysis  is  probably  clue  to  the  action  of  lead.  The  con- 
dition of  the  supinator  longus  is  easily  tested  in  the  following  way:  Extend  the 
paralyzed  forearm  on  the  table,  with  tlie  radius  upward,  then,  press  down  the 
wrist,  and  tell  the  patient  to  trj'  to  raise  it  from  the  table.  The  supinator  longus, 
if  not  paralyzed,  immediately  becomes  hard,  contracted,  and  stands  out  promi- 
nently.    (Erb.) 

The  muscles  of  the  ball  of  the  thumb  waste  greatly,  and  in  severer 
cases  the  deltoid,  and  even  the  muscles  of  the  neck  and  trunk  are  simi- 
larly affected.  Indeed,  in  the  worst  cases,  general  paralysis  may  occur, 
with  wasting  of  the  muscles  of  the  whole  body,  even  the  voice  becoming 
weak.  The  paralysis  mostly  affects  motion  only,  but  sometimes  there  is 
also  loss  of  sensation;  great  loss  of  electric  excitability  in  the  muscles 
occurs  early,  sometimes  before  loss  of  voluntary  jDower.  Epilepsy,  delir- 
ium, convulsions,  or  coma,  may  destroy  the  patient;  but  death  from 
chronic  lead  poisoning  is  uncommon. 

The  muscles  are  wasted,  grayish -red  or  whitish  and  tough,  with  considerable 
increase  of  tlie  interstitial  connective  tissue.  These  changes  are  similar  to  those 
which  occur  in  injury  to  nerves,  in  progressive  muscular  atrophy,  and  in  spinal 
pai'alysis  of  children. 

How  does  lead  produce  paralysis?  On  this  point  various  views  are  held. 
Some  maintain  that  lead  directly  affects  the  muscles  ;  others  that  it  arrests  n,utri- 
tion  by  exciting-  strong  contraction  of  the  blood-vessels  supplying-  the  wasted 
muscles.  The  existence  of  the  "  reaction  of  degeneration,"  as  tested  bj-  electricity, 
shows  that  the  atfection  is  seated  either  in  the  nerves  or  in  the  spinal  cord;  and 
probably  in  the  spinal  cord,  for  the  reaction  of  degeneration  and  atrophy  pursue 
exactly  the   same  course  as  in  the  spinal  paralysis  of  children. 

In  the  nervous  system  it  causes  hypera^mia  and  proliferation  of  neuroglia  with 
consequent  contraction,  causing  degeneration  of  tlie  cellular  elements. 

The  cramps  are  not  confined  to  the  muscles  of  the  extremities.  The 
intestines  are  also  affected,  sometimes  almost  throughout  their  length, 
but  generally  only  a  limited  extent  is  involved.  If  the  finger  is  jDassed 
up  the  rectum,  the  contractions  can  sometimes  be  felt.  The  blood-ves- 
sels, like  other  parts  of  the  body,  are  said  to  be  subject  to  cramps.  The 
kidneys  are  found  to  be  cirrhotic,  indeed,  in  many  fatal  cases  the  reis 
more  or  less  general  fibrosis. 

The  colic  is  generally  dependent  on  constipation;  for  when  this  is  set 
right  the  colic  generally  disappears. 

In  large  doses  lead,  like  the  other  heavy  metals,  may  induce  inflam- 
mation of  the  grey  matter  of  the  cord,  and  later  of  the  white  matter,  in- 
ducing symptoms  like  acute  general  myelitis,  with  rajjid  wasting  of  the 
muscle.     Chronic  lead  poisoning  causes  chronic  neuritis  and  myelitis. 

Chronic  lead  poisoning  excites  cirrhosis  of  the  kidney,  due,  it  is  said, 
to  the  deposits  of  lead  carbonate  in  Henie's  Ioojds,  these  deposits  acting 
as  irritants. 

The  influence  of  lead  on  the  urates  in  the  blood  is  most  singular.  Dr. 
Oarrod,  in  his  remarkable  investigations  concerning  gout,  has  elucidated 
this  subject,  and  shown  the  intimate  connection  existing  between  lead- 


18G  LEAD    SALTS. 

poisonint^  and  gont.  In  jifont,  as  tliis  philosophical  observer  has  shown, 
the  urates,  probal)ly  with  increased  formation,  are  retained  in  tlie  blood. 
In  gout,  especially  during  the  acute  attacks,  scarcely  any  uric  acid  is  to 
be  found  in  the  urine,  while  an  abundant  quantity  is  detectable  in  the 
blood.  The  urates  dissolved  in  the  blood  manifest  special  affinity  for 
particular  structures,  as  the  cartilages,  bursa?,  and  fibrous  tissues,  particu- 
larly of  certain  parts,  and  during  the  deposition  of  the  urates  in  the  joints, 
acute  inflammation  is  excited,  and  this  constitutes  gout.     (See  Colchicum.) 

Now,  lead  checks  the  separation  of  urates  from  the  blood  by  the 
kidneys,  diminishes  the  uric  acid  of  the  urine,  thus  greatly  augmenting 
that  of  the  blood,  and  thus  we  have  the  pathological  condition  which 
excites  the  gouty  inflammation.  Dr.  Garrod  has  further  shown — and  his 
experience  is  corroborated  by  all  Avho  have  investigated  this  subject — that 
gout  very  frequently  occurs  among  lead-workers,  and  that  gouty  patients 
often  exhibit  the  characteristic  blue  lead  line  on  their  gums. 

There,  too,  is  the  fact,  in  further  confirmation  of  Dr.  Garrod's  dis- 
coveries, that  if  to  a  gouty  person,  free  at  the  time  from  an  acute  attack, 
a  salt  of  leacl  is  administered,  it  developes  acute  gout,  with  its  accompany- 
ing symptoms  of  severe  pain  and  high  fever.  The  author  has  repeatedly 
verified  this  fact,  first  pointed  out  by  Dr.  Garrod,  which  affords  an  ex- 
planation, in  part  at  least,  of  the  good  effects  of  iodide  of  potassium  on 
gout,  since  as  we  have  shown  already,  this  salt  promotes  the  excretion  of 
lead. 

Lead  is  used  for  a  variety  of  purposes,  but  cliiefly  for  its  astringent 
action  on  the  tissues,  as  in  profuse  discharges  of  the  mucous  membrane, 
from  the  lungs  in  bronchitis,  and  to  check  bleeding  from  the  nose,  lungs, 
kidneys  and  uterus. 

It  has  been  conjectured  that  lead  in  Bright's  disease  might  check  the 
escape  of  albumen  from  the  blood,  and  therefore  lessen  the  amount  of  it 
in  the  urine,  and  George  Lewald  has  published  some  experiments  instituted  . 
with  a  view  of  testing  this  point.  He  does  not  mention  the  form  of  kidney 
disease  his  jDatients  suffered  from,  but  it  was  probably  the  pale,  flabby, 
fatty  kind.  He  observed  at  the  same  time  the  influence  of  the  lead  on  the 
amount  of  urine  voided.  These  experiments,  too  few  perhaps  to  decide 
the  question,  showed  that  lead  constantly  diminished  the  albumen  of  the 
urine,  though  only  to  a  very  small  extent,  namely,  to  about  nine  or  ten 
grains  in  the  twenty-four  hours.  The  diminution  appeared  to  hold  no 
relation  to  the  quantity  of  lead  administered.  The  quantity  of  water  was 
simultaneously  increased  on  an  average  by  200  c.c.  in  the  twenty-four 
hours.  Here  again,  the  increase  held  no  projDortion  to  the  quantity  of 
lead,  employed. 

M.  Paul,  who  has  investigated  the  influence  of  lead-poisoning  on  the 
foetus,  says  that  women  working  in  lead  factories  frequently  abort;  and 
that  the  father  may  cause  abortion,  even  when  the  mother  is  not  a  lead- 
worker.  In  123  pregnancies,  seventy-three  children  were  1)orn  dead;  and 
of  these,  sixty-four  w^ere  abortions,  four  premature  births,  and  five  born  at 
the  full  time.  Of  the  fifty  born  alive,  twenty  died  the  first  year,  eight  the 
second,  seven  the  third;  one  later,  and  only  fourteen  reached  the  age  of 
ten. 

We  know  but  little  concerning  the  elimination  of  lead.  Only  a  little 
lead  passes  off  with  the  urine:  iodide  of  potassium,  however,  increases  its 
elimination. 


]SriTRATE    OF    SILVER.  187 


NITRATE  OF  SILVER,    OXIDE   OF   SILVER. 

The  soluble  preparation  of  silver,  when  painted  on  the  skin,  colors 
it  first  an  opaque  white,  which  changes  gradually  to  brown  and  black. 
The  application  of  a  strong  solution  Avill  produce  vesicatio]i.  Nitrate  of 
silver  is  sometimes  applied  as  a  destructive  caustic  to  warts  and  other  ex- 
crescences, but  its  action  being  too  superficial  it  is  useless  for  this  purpose. 

Applied  to  the  abraded  skin,  or  to  sores,  the  soluble  silver  salts  form 
an  albuminate  which  coats  the  surface  with  a  thin  layer  and  protects  the 
tissues  beneath  from  the  irritation  of  the  air.  The  nitrate  of  silver  acts 
as  a  powerful  excitant  of  the  tissues  and  destroys  tliem,  but  only  very 
superficially.  It  is  frequently  applied  to  induce  healthier  growth  in  un- 
healthy and  unclean  ulcers,  giving  much  smarting  pain,  which,  however, 
soon  passes  away. 

Like  most  other  soluble  metallic  preparations,  the  nitrate  causes  con- 
densation of  the  tissues  as  well  as  contraction  of  the  blood-vessels,  on 
which  account  it  is  used  to  stay  haemorrhage;  being  liable,  however,  to 
excite  much  inflammation  and  pain,  other  blander  astringents  should  first 
be  tried.  Sometimes  it  is  used  to  check  the  bleeding  from  leech-bites  by 
touching  them  with  a  stick  of  nitrate  of  silver. 

Nitrate  of  silver  will  prevent  the  pitting  of  small-pox,  if  each  vesicle  is 
opened  as  soon  as  formed,  and  the  raw  surface  beneath  touched  with  a  solu- 
tion of  the  salt.  Dr.  F.  Bowen  has  recorded  an  instructive  case  showing 
the  efficacy  of  this  treatm^t.  He  treated  the  vesicles  on  one  side  of  the 
face  and  neck  in  the  way  described,  leaving  untouched  the  vesicles  on  the 
opposite  side,  with  the  result  that  on  recovery  the  untreated  side  was 
deeply  pitted,  while  the  opposite  side  remained  smooth  and  scarless.  Dr. 
Bowen,  who  has  devoted  much  attention  to  this  subject,  states  that  a  nurse 
can  easily  carry  out  the  process.  At  an  early  stage  of  the  eruption — at 
the  latest  on  the  fourth  or  fifth  day — he  punctures  the  vesicles  with  a  fine 
needle  dipped  in  a  solution  containing  twenty  grains  of  nitrate  of  silver  to 
an  ounce  of  water.  Mr.  Higginbottom  finds  it  unnecessary  to  puncture 
the  vesicles,  and  says  it  is  enough  to  paint  the  skin  in  the  manner  recom- 
mended by  him  in  erysipelas,  which  subdues  inflammation  and  prevents 
suppuration. 

Bed-sores  are  best  prevented  by  painting  the  threatened  but  unbroken 
skin  as  soon  as  it  becomes  red,  with  a  solution  of  nitrate  of  silver  {20 
grains  to  an  ounce),  with  the  effect  of  dispersing  the  redness,  hardening 
the  skin,  and  preventing  the  bed-sores,  unless,  as  in  the  ease  of  paralysis, 
there  is  a  great  proneness  to  this  lesion. 

That  species  of  boil  which,  beginning  first  as  a  papule,  maturates  into 
a  pustule,  and  inflames  and  extends  till  a  large  dead  core  is  produced,  may, 
it  is  said,  be  arrested  in  its  early  pustular  stage  by  painting  it  over  at  its 


188  IvlTEATE    OF    SILVER. 

Tery  commencement  with  a  strong  solution  of  nitrate  of  silver.  I  have 
had  no  experience  of  this  method,  but  of  the  beneficial  influence  of  collo- 
dion on  similar  boils,  to  be  mentioned  in  another  place,  I  can  speak  with 
great  confidence. 

Nitrate  of  silver  will  arrest  herpes  labialis  and  the  vesication  of  shingles, 
if  the  warning  patch  of  erythema  is  painted  over  lief  ore,  or  as  soon  as,  the 
vesicles  begin  to  form. 

We  sometimes  meet  with  a  patient  with  a  patch  of  lichen,  the  size  of 
the  palm  of  the  hand,  affecting  almost  any  part  of  the  body,  the  irritation 
from  this  patch  being  sometimes  so  excessive  as  even  to  break  the  sleep 
and  injure  the  health.  The  painting  the  patch  with  the  nitrous  ether 
solution  of  silver  every  day,  or  second  day,  as  the  itching  may  require, 
will  generally  cure  this  affection. 

Limited  patches  of  eczema  are  sometimes  benefited  in  the  same  way. 
Nitrate  of  silver  proves  most  serviceable  after  the  weeping  stage. 

The  occasional  application  of  nitrate  of  silver  or  sulphate  of  copper  is 
serviceable  in  psoriasis  of  the  tongue  and  mucous  membrane  of  the  mouth, 
but  if  it  depends  on  syphilis  mercurial  applications  are  Ijest.  A  Aveak  solu- 
tion of  nitrate  of  silver,  gradually  strengthened,  is  stated  to  be  useful  in 
the  superficial  kinds  of  lupus. 

Higginbottom  very  strongly  recommends  the  local  application  of  nitrate 
of  silver  in  erysipelas.  No  agent,  he  says,  is  so  safe  or  so  efficacious  in 
subduing  external  inflammations;  but  he  points  out  that  the  success  of 
this  treatment  depends  entirely  on  the  manner  of  conducting  it.  He 
directs  the  skin  to  be  well  washed  with  soap  and  water,  then  with  simple 
water,  then  to  be  wiped  quice  dry;  next  a  solution  of  four  scruples  of  the 
brittle  stick  of  nitrate  of  silver,  in  four  drachms  of  water,  is  to  be  applied 
two  or  three  times  to  the  inflamed  surface,  extending  two  or  three  inches 
beyond  it. 

Nitrate  of  silver  often  cures  the  intolerable  itching  of  pruritus  puden- 
di.  A  large  camel-hair  brush,  saturated  in  a  solution  containing  from 
two  to  five  grains  to  the  ounce,  should  be  painted  three  or  four  times  a 
day  over  the  vulva,  and  be  thrust  up  to  the  os  uteri.  A  stronger  solution 
used  less  frequently  will  not  answer  so  well.        , 

A  weak  solution  of  nitrate  of  silver  often  relieves  pruritus  ani. 

Pruritus  of  the  meatus  auditorius,  occurring  without  any  eruption, 
should  be  treated  by  the  application  of  a  strong  solution  of  nitrate  of 
silver,  carefully  avoiding  the  membrana  tympani.  If  the  itching  arises 
from  undue  dryness  of  the  ear,  from  deficient  secretion  of  Avax,  almond 
oil  or  glycerine  should  first  be  tried. 

When  used  as  an  outward  application,  nitrous  ether  is  by  far  the  best 
solvent  of  nitrate  of  silver,  for,  by  dissolving  the  fatty  matters  of  the 
skin,  this  solution  forms  a  uniform  layer  over  the  surface,  unlike  a  Avatery 
one,  which  runs  into  drops,  leaving  the  intermediate  skin  dry.  This  solu- 
tion is  not  available  in  erysipelas,  as  nitrous  ether  will  not  dissolve  the 
quantity  of  silver  required.  It  is  important  to  bear  in  mind  that  a  nitrous 
ether  solution  acts  much  more  strongly  than  an  aqueous  solution  of  corre- 
sponding strength.  The  ether  solution  must,  therefore,  be  made  weaker, 
five  to  ten  grains  to  the  ounce  being  generally  strong  enough.  Five 
grains  to  the  ounce  is  sufficiently  strong  for  threatened  bed-sore,  a 
stronger  solution  often  blistering,  particularly  on  applying  several  coats. 

Solutions  of  nitrate  of  silver  are  used  to  blacken  the  hair  of  the  head. 
The  hair  is  first  washed  with  the  solution  of  nitrate  of  silver,  and  then  a 


NITRATE    OF    SILVER.  189 

comb,  dipped  into  a  solution  of  snlpliide  of  potassium,  is  passed  through 
it;  a  process  resulting  in  the  production  of  a  dull,  lustreless,  ghastly, 
black-bhiish  color= 

In  obstinate  tinea  tarsi,  the  solid  nitrate  of  silver  stick  is  sometimes 
passed  over  the  edges  of  the  e3'elids,  first  removing  the  eyelashes  and  the 
scabs. 

In  conjunctivitis,  a  few  drops  of  a  sohition  of  nitrate  of  silver,  varying 
in  strength,  is  inserted  -with  the  aid  of  a  quill  several  times  a  day  into  the 
eye,  exciting  in  the  membrane  a  healthier  inflammation,  which  soon 
subsides. 

The  nitrate  may  be  applied  to  ulcers  of  the  mouth.  When  a  milder 
application  than  the  ordinary  caustic  is  required,  it  is  convenient  to  use 
the  sticks  composed  of  equal  parts  of  nitrate  of  silver  and  nitrate  of  potash. 

The  soluble  salts  have  an  astringent  metallic  taste. 

In  the  early  stages  of  inflammation  of  the  throat,  when  the  inflamma- 
tion is  superficial,  and  there  is  only  a  little  swelling,  the  application  of  a 
strong  solution,  or  of  the  solid  stick  of  nitrate  of  silver,  subdues  and  some- 
times even  extinguishes  the  inflammation. 

In  chronic  sore  throat,  when  the  tissues  are  relaxed  and  covered  with 
pus,  solutions  of  the  nitrate  are  serviceable;  but  the  author  does  not  think 
they  are  superior  in  any  way  to  strong  astringent  and  unirritating  applica- 
tions. Even  ulcers  are  best  treated  by  the  glycerine  of  tannin;  but  if  in 
a  sloughing  and  unhealthy  condition,  then  the  irritant  nitrate  must  be 
preferred.  The  nitrate  of  silver  is  also  applied  with  doubtful  benefit  in 
diphtheria.  Most  authorities  are  agreed  that  the  application  should  be 
limited  to  the  inflamed  patches;  for  if  applied  beyond  their  area,  it  excites 
an  extension  of  the  inflammation,  on  which  the  false  membrane  may 
readily  implant  itself. 

Nitrate  of  silver,  m  powder  or  solution,  is  sometimes  applied  by  means 
of  a  probang,  l)rush  or  sponge,  to  the  chronically  inflamed  larynx,  as  in 
phthisis;  or  solutions  of  nitrate  of  silver,  in  the  proportion  of  gr.  -^  to  gr.  v 
to  the  ounce  of  water,  may  be  brought  to  bear  on  the  pharynx  and  lar^'nx 
by  the  spray-producer. 

Dr.  Horace  Green  injects  a  solution  of  nitrate  of  silver  into  the_  trachea 
in  asthma,  bronchitis,  and  phthisis,  after  deadening  the  sensibility  of  the 
glottis,  by  applying  to  it  for  one  or  two  weeks  a  solution  of  nitrate  of  silver. 
He  passes  a  No.  10  or  12  catheter,  which  produces  only  a  sensation  of 
warmth,  through  the  rima  glottidis,  down  even  to  the  bifurcation  of  the 
trachea,  and  injects  the  solution.  The  late  Dr.  Hughes  Bennett,  who  en- 
dorsed this  treatment,  injected  either  two  drachms  of  a  solution  contain- 
ing half  a  drachm  of  nitrate  of  silver  to  an  ounce  of  water,  or  even  half 
an  ounce  of  a  solution  consisting  of  forty  grains  of  nitrate  of  silver  to  an 
ounce  of  water.  While  introducing  the  catheter,  the  head  is  thrown 
back,  and  the  tongue  drawn  forward,  when  the  instrument  glides  along 
the  laryngeal  surface  of  the  epiglottis,  Avhicli  is  nearly  insensible,  through 
the  rima  glottidis  itself. 

Sponging  out  the  throat  with  a  solution  of  nitrate  of  silver  greatly 
diminishes  the  violence  and  frequency  of  the  paroxysm  in  whooping-cough, 
renders  the  cough  but  half  as  frequent,  makes  the  fits  much  less  severe, 
and  enables  a  child  harassed  with  broken  sleep  to  obtain  a  good  night's 
rest.  But  there  is  a  formidable  drawback  to  this  treatment;  for  the  ap- 
plication generally  produces,  especially  with  very  young  children,  so  vio- 
lent an  attack  of  coughing,  as  to  excite  fears  lest  suffocation  should  ensue. 


190  ]S'ITRATE    OF    SILVER. 

Instead  of  si^onging  the  throat,  the  nitrate  of  silver  may  be  applied  in  the 
form  of  spray  by  the  atomizer.  Very  young  children,  however,  cannot 
be  inducetl  to  open  their  months,  and  allow  the  inlialation  of  the  spray; 
hence  its  use  is  restricted  to  children  more  than  two  or  three  years  old. 
These  applications,  being  apt  to  excite  retching,  should  be  employed  when 
the  stomach  is  empty. 

Any  part  of  the  salt  ha\'ing  escaped  conversion  in  the  mouth  is  changed 
into  an  albuminate  when  it  enters  the  stomach;  and  if  sufficient  albumen 
is  not  present  to  effect  this,  the  salt  attacks  the  mucous  membrane,  and 
excites  active  inflammation.  The  best  antidote  for  a  poisonous  dose  is 
common  salt,  a  fact  useful  to  bear  in  mind,  if,  as  sometimes  happens,  the 
solid  stick  of  nitrate  breaks  off  and  is  swallowed. 

Xitrate  of  silver  acts  as  an  irritant  in  the  stomach,  and  may  be  used  in 
precisely  the  same  class  of  cases  for  which  arsenic  is  applicable.  It  often 
checks  the  pain  and  vomiting  of  chronic  inflammation,  of  chronic  ulcer, 
and  even  of  cancer  of  this  organ.  It  should  not  be  given  in  the  form  of 
a  pill,  but  in  solution. 

The  nitrate  acts  as  an  astringent  in  the  intestines,  and,  in  common 
with  several  other  metallic  preparations,  may  ])e  used  in  diarrhoea,  both 
of  the  acute  and  chronic  kind. 

Peptones  readily  dissolve  the  nitrate,  and  the  solution  does  not  coagu- 
late albumen.  Probably  it  enters  the  blood  in  this  form  and  collects  in 
the  red  corpuscles,  as  other  metals  tend,  to  do  if  not  speedily  deiiosited  in 
the  organs  or  separated  by  the  secretions.  The  red  corpuscles  are  said  to 
become  paler  and  the  haemoglobin  to  be  converted  into  ha?matin,  and  it 
is  conjectured  that  this  change  explains  the  slight  fall  in  temperature  after 
large  doses  of  silver  salts.  These  salts,  being  absorbed,  are  supposed  to 
be  astringent  to  the  tissues  to  which  they  are  conveyed,  but  this  is  a  doubt- 
ful supposition,  and  they  are  never  used  to  check  either  bleeding  or  secre- 
tion from  the  distant  organs  of  the  body. 

In  poisonous  doses  nitrate  of  silver  excites  in  animals  convulsions  and 
paralysis,  probably  central  in  origin;  the  convulsions,  being  very  similar 
to  those  produced  by  strychnia,  are  excited  by  the  least  peripheral  irrita- 
tion. Death  is  said  to  be  due  to  asphvxia,  and  the  lungs  are  found  con- 
gested and  oedematous  and  the  bronchial  tubes  choked  with  mucus.  In- 
jected into  a  vein  nitrate  of  silver  desti'oys  contractibility  of  the  cardiac 
muscle. 

Chronic  poisoning  by  nitrate  of  silver  produces  loss  of  appetite,  im- 
paired nutrition,  albumen  in  the  urine,  rapid  and  irregular  action  of  the 
heart,  and  after  death  there  is  found  general  fatty  degeneration,  especially 
of  the  kidneys,  liver,  and  heart. 

Both  the  oxide  and  nitrate  are  employed  in  chorea  and  epilepsy,  ap- 
l^arently  with  occasional  benefit.  The  oxide  has  been  given  to  check 
profuse  sweating.  Xitz'ate  of  silver  is  sometimes  very  useful  as  an  injec- 
tion in  acute  and  chronic  dysentery  (  3  j  to  three  pint's  of  injection).  If 
administered  too  long,  these  substances,  in  some  form,  probably  as  the  re- 
duced metal,  are  deposited  in  all  the  tissues  of  the  skin,  except  the  rete 
malpighii,  and  most  abundantly  Avhere  the  skin  is  finest  and  most  vascu- 
lar; but,  once  deposited,  the  metal  remains  as  a  permanent  discoloration, 
of  a  deep  leaden  hue,  either  by  time  or  treatment  irremovaljle,  unless  it 
should  prove  true  that  large  doses  of  iodide  of  potassium,  as  has  been 
lately  stated,  will  wash  out  the  stain.  Dr.  W.  Pepper  finds  that  the 
staining  of  the  skin  is  always  preceded  by  a  dark  line  upon  the  gums. 


MERCURY.  191 

Silver  appears  to  be  chiefly  eliminated  by  tlie  intestines  and  bile,  very 
little  escaping  by  the  urine. 

The  nitrate,  in  solutions  of  various  strength,  is  used  as  an  injection  in 
gonorrhoea.  Some  advocate  a  very  strong  solution  (twenty  grains  to  the 
ounce),  averring  that  in  many  instances  the  disease  may  at  once  be  cut 
short  by  it;  others  prefer  a  much  weaker  solution  of  one  or  two  grains  to 
the  ounce  of  water,  repeating  the  injection  several  times  a  day. 


MEECURY  AND   ITS  PREPARATIONS. 

The  salts  of  mercury  possess  very  various  physical  as  well  as  chemical 
properties;  but  as  in  every  instance  their  effect  on  the  system  is  well-nigh 
the  same,  probably  all  mercury  compounds  ultimately  assume  the  same 
form  in  the  blood. 

The  nitrates  of  the  oxide  and  suboxide  are  escharotic;  but  much  of 
this  action  is  due  to  the  free  nitric  acid  of  the  salt.  They  are  used  to 
remove  warts,  condylomata,  and  other  slight  excrescences.  Mercurial  ap- 
plications Avill  completely  allay  the  annoying  itching  of  certain  skin  affec- 
tions. Solutions  of  bichloride,  black-wash,  yellow-Avash,  or  mercurial 
ointment,  may  each  prove  useful,  but  the  application  must  be  a  strong 
one.  Trousseau  highly  recommends  bathing  the  part  with  a  solution  of 
about  twelve  grains  of  bichloride  in  a  pint  of  very  warm  water.  After 
much  experience  of  these  applications,  I  believe  that  far  the  best  applica- 
tion is  an  ointment  composed  of  a  drachm  of  calomel  to  an  ounce  of  lard; 
but  this  ointment,  in  common  with  other  mercurial  applications,  is  not 
useful  in  all  kinds  of  itching;  for  instance,  it  is  unavailing  in  the  irritation 
of  urticaria. 

Calomel  ointment  often  immediately  removes  the  itching  of  pruritus 
ani  and  neighboring  parts.  This  irritation  may  be  due  to  rashes,  as 
psoriasis,  lichen  or  eczema,  or  no  eruption  may  be  visible,  yet  the  oint- 
ment will  prove  equally  efficacious.  This  application  is  less  frequently 
useful  in  pruritus  pudendi.  In  obstinate  cases  of  pruritus  ani  and  pruritus 
pudendi,  blisters  to  the  thighs,  or  the  application  of  a  few  leeches,  some- 
times afford  relief. 

The  ointment  in  many  instances  improves  the  rashes  themselves,  but 
this  is  in  some  measure  due  to  the  cessation  of  the  scratching,  on  the  dis- 
appearance of  the  itching. 

Sometimes  a  little  scabbiness  of  the  head,  looking  like  mild  eczema, 
occurs  in  children,  accompanied  by  a  degree  of  itching,  sufficient  to  prevent 
sleep,  and  to  cause  constant  restlessness.  The  calomel  ointment  speedily 
appeases  this  irritation. 

The  inunction  with  calomel  ointment  allays  the  distressing  itching  of 
the  scalp  sometimes  accompanying  pityriasis.  It  may  be  profitably  added 
to  other  ointments  used  for  the  removal  of  pityriasis,  as  oxide  of  mercury 
or  of  tar. 


192  MERCURY. 

It  may  be  objected  that  so  strong  an  application  of  mercury,  especially 
when  applied  to  soft  and  absorbing  parts,  as  the  inner  surface  of  the  vulva, 
and  the  skin  around  the  anus,  must  surely  produce  salivation.  No  doubt 
care  should  l)e  exercised,  and  no  more  ointment  used  than  is  needed. 
Yet  the  risk  of  salivation  seems  to  be  extremely  slight,  for,  with  a  very 
large  experience  of  the  ointment,  I  have  never  seen  salivation  produced  by 
it.  Properly  applied,  a  very  small  piece  of  ointment  is  generally  sufficient 
to  allay  the  irritation  at  once,  and  even  to  remove  it  altogether  in  a  few 
days,  although  it  is  very  apt,  after  a  variable  time,  to  return,  when  it 
again  yields  to  a  renewed  employment  of  the  unguent.  Its  grateful  effects 
are  often  almost  instantaneous,  though  sometimes  it  takes  a  few  davs  to 
give  ease.  Having  many  times  seen  it  succeed  when  other  remedies  have 
entirely  failed,  I  am  convinced  of  the  value  of  this  ajiplication  in  these  har- 
assing and  perverse  diseases.  An  ointment  composed  of  five  to  ten  grains 
of  menthol  to  an  ounce  of  s^Dermaceti  ointment  is  also  very  useful.  The 
smaller  quantities  must  be  first  tried,  as  the  larger  may  be  too  irritating. 

The  white  precipitate,  or  nitrate  of  mercury  ointment,  or  corrosive- 
sublimate  wash,  will  destroy  the  various  kinds  of  lice  and  their  nits,  which 
infest  different  parts  of  the  body.  For  lice  on  the  pubes  it  is  necessary 
to  apply  the  ointment  or  lotion  to  the  scrotum,  hair  on  the  perineum, 
and  around  the  anus.  The  nits  can  be  dislodged  by  washing  the  hairs 
with  spirits  of  wine,  which  dissolves  the  gluey  matter  so  strongly  attach- 
ing the  nit  to  the  hair.  The  body-louse  may  be  killed  by  the  essential 
oils,  as  the  oil  of  rosemary,  or  by  powdered  pyrethrum,  or  by  an  ointment 
of  staphisagria.  Through  the  groundless  fear  of  inducing  salivation  some 
prefer  these  to  mercurial  applications.  The  under  linen  should  be  boiled 
to  destroy  any  hidden  lice. 

The  irritant  ointments  of  mercury  are  useful  in  that  obstinate  and 
disfiguring  affection,  tinea  ciliaris.  The  eyelashes  should  be  cut  short, 
and  the  ointment,  either  of  nitrate  or  oxide  of  mercury,  applied  night  and 
morning,  picking  off  the  scabs  before  each  dressing.  It  is  a  common 
practice  to  dilute  the  unguentum  hydrargyri  nitratis  with  from  four  to 
six  parts  of  simple  ointment,  Avhether  used  for  rashes  or  tinea  ciliaris,  but 
in  many  instances  the  undiluted  ointment  is  best,  and  it  seldom  requires 
to  be  reduced  more  than  half  the  officinal  strength,  for  the  failure  of  the 
ointment  in  eczema,  psoriasis,  lichen,  and  tinea  ciliaris,  is  often  due  to  its 
employment  in  too  weak  a  form.  Mr.  Hutchinson  and  others  assert  that 
epilation  ensures  the  speediest  cure.  Should  these  stimulating  applica- 
tions fail,  others  more  powerful  should  be  tried,  as  nitrate  of  silver,  or 
sulphate  of  copper,  the  last-named  salt  being  preferable,  as  it  gives  less 
pain. 

Patches  of  obstinate  lichen  and  psoriasis,  especially  of  the  hands,  even 

Avhen  not  syphilitic,  will  sometimes  yield  to  mercury  ointment  when  milder 

,  treatment  fails.     The  calomel  and  nitrate  of  mercury  ointment  may  be 

mixed,  and  the  addition  of  tar  ointment  sometimes  increases  the  efficacy 

of  this  combination. 

Citrine  ointment  is  also  very  useful  in  some  cases  of  eczema,  even  in 
the  weeping  stage,  if  there  is  but  little  inflammation,  but  it  is  esj)ecially 
useful  in  the  stage  of  desquamation  when  the  skin  has  healed.  It  is 
markedly  serviceable  when  eczema  affects  the  hairy  parts  of  the  face, 
often  curing  this  obstinate  form  when  other  remedies  have  been  tried  in 
vain,  and  even  when  it  fails  to  cure,  it  generally  in  great  part  subdues 
the  disease.  The  same  ointment  is  very  beneficial  too  in  pityriasis  of  the 
hairy  part  of  the  face.     In  both  eczema  and  pityriasis  it  is  better  to  mix 


MERCURY.  193 

it  with  tar  ointment,  though  this  combination  is  sometimes  more  irritating 
than  the  simple  citrine  ointment.  Not  unfrequently  this  mixture  cannot 
be  borne,  whilst  the  citrine  ointment,  pure  or  diluted,  proves  very  useful. 

In  the  early  stages  of  acne,  a  lotion  composed  of  corrosive  sublimate, 
one  part;  alcohol,  enough  to  dissolve  it;  water,  100  parts,  is  said  to  be  of 
use.  A  teas})oonf  ul  is  to  be  added  to  a  quarter  of  a  pint  of  water,  and  the 
face  sponged  with  the  lotion  night  and  morning.  The  bichloride  lotion 
after  a  time  produces  a  "  scaliness  and  hardness  of  the  cuticle." 

Bichloride  of  mercury,  one  of  the  best  parasiticides,  is  useful  in  favus, 
tinea  sycosis,  tinea  tonsurans,  eczema  marginatum,  and  pityriasis  versicolor 
(chloasma).  A  lotion  containing  two  grains  of  bichloride  to  an  ounce  of 
water  is  generally  sufficiently  strong.  In  favus,  and  tinea  sycosis,  and  tinea 
tonsurans,  the  lotion  should  be  applied  after  each  epilation,  and  should 
be  continued  for  some  time  after  epilation  is  stopped.  This  treatment 
is  highly  spoken  of  by  McCall  Anderson. 

It  is  tauglit,  on  high  authority,  that  the  application  of  mercury  oint- 
ment in  paronychia  is  very  useful,  repeated  for  ten  minutes  every  hour, 
applying  poultices  at  other  times.  Dr.  Scott  reports  several  striking  cases 
of  cures  by  dusting  nitrate  of  lead  on  the  diseased  tissues  night  and 
morning. 

^lercurial  preparations  are  used  as  local  applications  in  chronic  in- 
flammation; for  instance,  Scott's  ointment  is  often  employed  in  chronic 
inflammation  of  the  knee-joint.  Mr.  John  Marshall  has  introduced  a 
mercurial  preparation,  oleate  of  mercury,  varying  in  strength  according 
to  the  needs  of  the  case,  and  variously  combined  with  other  remedies. 
Mr.  Marshall's  paper  is  so  practical  and  valuable,  and  so  insusceptible 
of  condensation  or  abridgment,  that  we  have  deemed  it  best  to  reproduce 
the  larger  portion  of  it.  "  These  preparations,"  he  says,  "  are  cleanly 
and  economical,  and  have  a  much  greater  diffusibility  or  penetrating 
power  than  the  old  mercurial  ointments,  for  they  are  absorbed  by  the 
skin  with  remarkable  facility,  and  manifest  the  remedial  effects  with 
great  promptitude." 

"  They  should  not  be  rubbed  in  hke  ordinary  liniments  or  embrocations,  but  should 
be  merely  applied  with  a  brush,  or  be  spread  lightly  over  the  part  with  one  finger;  other- 
wise they  may  cause  cutaneous  irritation,  or  even  produce  a  few  pustules  on  the  skin, 
especially  in  certain  persons.  This  result  may,  however,  be  obviated  by  the  addition 
of  a  small  quantity  of  olive  oil,  or  puritied  lard,  according  as  an  oleaginous  or  an  unc- 
tuous preparation  is  required.  Any  of  these  forms  may  be  scented  by  the  addition, 
of  essential  oils. 

"  In  employing  these  mercurial  solutions  for  combating  persistent  inflammations  of 
joints,  I  soon  found  that  the  addition  of  morphia  was  of  very  great  advantage.  For  this 
purpose  the  simple  alkaloid  must  be  used,  as  neither  the  liydrochlorate,  the  acetate, 
nor  the  mecouate,  is  soluble  in  oleic  acid.  For  every  drachm  of  the  solution  of  oleate 
of  mercury  in  oleic  acid,  one  grain  of  morphia  may  be  added.  Being,  as  well  as  the 
mercury,  completely  dissolved,  it  quite  as  rapidly  penetrates  the  skin,  comes  quickly 
into  contact  with  the  extremities  of  the  nerves,  and  thus,  even  within  a  few  minutes, 
acts  upon  them  at  their  most  sensitive  points,  and  speedily  produces  a  soothing  eifect. 

The  oleates  of  mercury  and  morphia,  thus  united  in  one  preparation,  represent,  as 
it  were,  a  liniment,  ointment,  or  plaster  of  mercury  and  opium;  but  they  are  far  more 
elegant,  economical,  and  efficacious.  As  a  rule,  according  to  the  size  of  the  part 
affected,  from  ten  to  thirty  drops  are  sufficient  for  one  application.  This  should  be 
repeated  twice  daily  for  four  or  five  days,  then  at  night  only  for  four  or  five  other 
days,  and  afterward  every  other  day  until  a  cure  is  obtained.  The  morphia  immedi- 
ately begins  to  relieve  pain,  allays  the  nervous  irritation,  and  consequent  vascular  tur- 
gescence;  and  thus  arrests  the  progress  or  '  persistence  '  of  the  inflammatory  process; 
whilst  the  mercury  probably  promotes  the  death  and  degeneration  of  the  morbid  prod- 
ucts, and  so  facilitates  their  subsequent  removal  by  absorption.    Unless  used  in  excess- 


1 04  MERCURY. 

ive  qllantit}^  the  oleate  of  mercury  does  not  salivate,  or  produce  any  marked  constitu- 
tional disorder." 

Mr.  Marsliall  says  "  their  applicability  and  utility  appear  to  me  to  ]je 
almost  co-extensive  with  the  occurrence  of  '  persistent '  or  chronic  inflam- 
mations, provided  only  that  the  seat  of  the  disease  be  in,  or  sufficiently 
near  to,  the  skin." 

"  I  may  first  mention  that  not  only  in  persistent  articular  inflammation,  hut  also  in 
simple  synovitis,  these  remedies  rapidly  relieve  the  tenderness  and  pain,  and  promote  the 
absorption  of  the  fluid  elf  used  into  a  joint.  They  are  also  of  decided  benefit  in  the  rheu- 
matic, the  arthritic,  and  the  mixed  forms  of  joint  disease;  but  in  these  they  do  not,  of 
course,  supersede  the  necessity  for  general  treatment.  In  inflammation  of  tlie  mam- 
mary gland,  occurring  during  or  after  lactation,  or  altogether  independently  of  that 
secreting  process,  their  efficacy  is  unequivocal;  for  I  have  seen,  not  only  the  induration 
left  after  previous  abscesses  speedily  disappear  under  their  use,  but  a  tendency  to  re- 
current svippuration  in  the  site  of  old  abscesses,  and  the  threatened  formation  of  new 
ones,  entirely  controlled  and  arrested.  I  have  also  seen  a  threatened  aljscess  in  the 
perinajum  from  inflammation  of  one  of  Cowper's  glands,  and  likewise  the  froul)lesome 
indurations  left  after  ordinary  perinteal  abscess,  rapidly  disappear  on  the  use  of  these 
preparations.  In  obstinate  and  painful  tonsillitis,  in  epididymitis,  in  periostitis,  and 
in  inflammation  with  imminent  or  actual  suppm-ation  in  or  around  lymphatic  glands, 
I  have  similarly  employed  them  with  decided  advantage.  In  hyiirocele  they  have 
not  appeared  to  l)e  useful.  I  have  used  equal  parts  of  the  20  per  cent,  ointment  and 
purified  lard  applied  outside  the  eyelid  with  success,  in  hordeolum,  and  in  palpeljral 
conjunctivitis. 

"  In  raanjr  cutaneous  affections  the  oleate  of  mercury  solutions,  without  morphia, 
form  elegant  and  powerful  remedies.  It  was  in  a  case  of  obstinate  sycosis  menti  that 
I  first  used,  and  with  excellent  results,  an  ethereal  solution  of  the  perchloride  of  mer- 
cury mixed  with  oleic  acid;  but  I  now  much  prefer,  as  equally  efficacious,  and  far  less 
irritating,  the  5  per  cent,  solution  of  oleate  of  mercury  in  oleic  acid,  with  the  addition 
of  an  eighth  part  of  ether.  (Dr.  Alder  Smith  employs  a  10  per  cent,  solution.)  Tliis, 
when  applied  to  the  skin  with  a  camel-hair  pencil,  is  a  most  diffluent  and  penetrating 
remedy.  It  enters  the  hair  follicles  and  the  seljaceous  glands,  penetrates  the  hiurs 
themselves,  and  carries  everywhere  with  it  its  powerful  metallic  constituent.  Besides 
sycosis,  it  will  cure  chloasma  and  the  various  forms  of  tinea;  it  is  useful  in  porrigo, 
and  in  pruritus  ani  et  pudendi;  but  I  have  not  found  it  serviceable  in  non-specific 
psoriasis,  or  in  eczema.  The  solution  of  oleate  of  mercury  destroys  pediculi  immedi- 
ately; and,  owing  to  its  singular  power  of  permeation,  simultaneously  kills  the  ova — 
a  result  not  always  certain  when  ointments  containing  undissolved  luercury  are  used. 

"Again,  in  man}'  of  these  syphilitic  affections  for  the  cure  of  which  mercury  is  ap- 
plicable, the  oleate  of  mercury  preparations  offer  some  advantages.  Thus,  in  congeni- 
tal syphilis,  a  piece  of  the  20  per  cent,  ointment,  about  the  size  of  a  pea  or  bean,  placed 
in  the  child's  axilljio  night  and  moi'ning  for  five  or  six  days,  rapidly  and  easily,  and 
without  any  signs  of  uncleanliness,  produces  constitutional  effects.  Even  in  the  adult 
this  mode  of  introducing  mercury  into  the  system,  either  for  the  cure  of  syphilis  or 
other  disease,  may  be  often  preferalile  to,  and  less  troublesome  than  the  bath,  and  it 
certainly  gets  rid  of  the  o):)jections  to  the  ordinarj'  mode  of  inunction.  As  a  topical 
remedy  for  certain  local  manifestations  of  syphilis,  such  as  the  non-ulcerated  forms  of 
syphiloderma,  especially  when  these  disfigiu-e  the  head,  face,  neck,  or  hands,  the  10 
per  cent,  solution  is  a  most  valuable  adjimct  to  other  treatment,  the  spots  rapidly  disap- 
pearing under  its  use.  This,  or  the  20  per  cent,  preparation,  diluted  -with  equal  parts 
of  purified  lard,  may  also  be  applied  to  non-idcerated  syphilitic  indurations  and  con- 
dylomata, but  it  gives  pain  if  applied  to  surfaces  much  excoriated  or  ulcerated,  to 
moist  warts,  or  to  mucous  membranes.  In  syphilitic  iritis,  and  also  in  non-siu'citic 
forms  of  that  disease,  this  diluted  oleate  ointment  smeared  over,  not  within,  the  eyelid, 
evidently  ])romotes  the  absorption  of  the  effused  lym])h.  Lastly,  in  some  of  the  re- 
moter kinds  of  syphilitic  affections,  which  iodide  of"  potassium  will  usually  cure,  such 
as  very  hard  nodes  and  certain  forms  of  syi)hilitic  testicle,  the  external  application  of 
the  oleate  of  mercury  is  very  valuable.  I  have  seen  a  case  of  enlarged  testicle,  epi- 
didymis, the  syphilitic  origin  of  which  iiad  not  been  suspected,  and  for  which  no  mer- 
curial course  had  been  prescribed,  ))ut  which,  during  a  period  of  six  years  had  been, 
from  time  to  time,  relieved  by  enormous  do.ses  of  iodide  of  potas.sium,  speedily  and 
decidedly  benefited  by  the  inunction  of  the  20  per  cent,  mercurial  oleate. 


MERCURY.  195 

■'In  reference  to  other  uses  of  the  combined  oleates  of  mercury  and  morphia,  I 
may  remark  that  I  cannot  doubt  their  value  in  the  treatment  of  '  persistent '  inflamma- 
tion of  certain  internal  parts  and  organs — as,  for  example,  of  obstinate  pleurisy,  pneu- 
monia, pericarditis,  and  endocarditis;  for  they  would  here  also  allay  pain  and  nervous 
Irritation;  would  thus  contribute  toward  the  arrest  of  progressive  disease,  and  would 
likewise  promote  the  process  of  absorption.  Moreover,  I  may  state  that  a  solution  of 
morphia  in  oleic  acid  (one  or  two  grains  to  the  drachm  without  mercury),  is  an  excel- 
lent topical  remedy  in  neuralgia,  and  in  that  exquisitely  painful  affection,  herpes  zoster, 
care  being  taken  not  to  produce  cutaneous  irritation  by  friction.  I  have  also  used, 
endermically,  with  advantage,  a  solution  of  atropia  in  oleic  acid,  and  have  had  pre- 
pared for  me  the  oleates  of  zinc  and  copper.  Each  of  these  preparations  will  probably 
come  to  have  its  uses,  to  which,  however,  I  have  now  only  time  thus  generally  to  refer. 
Oleic  acid  is  likewise  a  ready  solvent  of  cantharidine  and  croton  oil.  It  is  itself  aperi- 
ent, and  permeates  fieces  more  readily  than  olive  oil.  Indeed,  I  fully  anticipate  that 
this  acid,  as  well  as  its  compounds  with  mercury  and  with  morphia,  besides  other 
preparations  made  by  its  aid,  will  eventually  be  admitted  into  the  Pharmacopana.  An 
ointment  of  the  oleate  of  mercury  would  almost  supersede  the  old-fashioned  blue 
ointment,  Avhilst  the  solutions  of  tlie  oleates  might  replace  the  liniment  of  mercury. 
The  remaining  mercurial  ointments  of  the  Pliarmacopo?ia,  of  which  the  nitrate  may 
contain  a  little  oleate  or  some  allied  salt,  will,  however,  still  have  their  special  uses. 

"  The  oleate  must  be  prepared  with  the  oxide  precipitated  by  caustic  potash  or 
soda  from  a  solution  of  Lhe  metal  in  nitric  acid  recently  made  and  well  dried.  The 
solution  of  mercury  by  oleic  acid  is  assisted  by  a  temperature  of  300°  Fah. 

"  The  5  per  cent,  solution  is  a  perfectly  clear,  pale  yellow  liquid,  resembling  olive 
oil,  but  thinner;  the  10  per  cent,  solution  is  also  fluid  and  perfectly  clear,  but  as  dark 
as  linseed  oil;  whilst  the  30  per  cent,  preparation  is  an  opaque,  yellowish,  unctuous 
substance,  closely  resembling  in  appearance  resin  ointment,  melting  very  readily  at 
the  temperature  of  the  body,  and  forming  a  kind  of  transparent,  viscid,  colorless  var- 
nish when  applied  to  the  skin.  The  chief  care  to  be  observed  in  the  manufacture  of 
these  solutions  is  not  to  hurry  the  process,  and  not  to  employ  a  high  temperature,  or 
the  mercury  will  be  Immediately  reduced. ' ' 

Baths  of  corrosive  sublimate  and  chloride  of  ammonium,  in  the  pro- 
portion of  half  an  ounce  of  sublimate  to  one  ounce  of  the  chloride,  are 
sometimes  useful  in  the  treatment  of  obstinate  syphilitic  and  non-s3qjliilitic 
rashes. 

An  ointment  of  l^iniodide  of  mercury  has  been  largely  employed  in  India 
with  remarkable  success  in  the  treatment  of  goitre.  The  action  of  the 
ointment  is  aided  by  the  effects  of  the  sun's  rays,  to  which  the  tumor  is 
exposed  after  inunction.  The  ointment  is  prepared  in  the  following  way: 
— Melt  three  pounds  of  lard  or  mutton  suet,  strain,  and  clean;  when 
nearly  cool,  add  nine  drachms  of  biniodide  of  mercury,  finely  triturated; 
work  the  mixture  well  in  a  mortar  till  no  grains  of  red  are  visible,  and 
keep  it  in  pots,  protected  from  the  light.  In  India  this  ointment  is  ap- 
plied to  the  swelling  at  sunrise  by  means  of  an  ivory  spatula,  and  is 
then  well  rubbed  in  for  at  least  ten  minutes. 

The  patient  then  sits  with  the  goitre  held  up  to  the  sun  as  long  as  he 
can  endure  it.  In  six  or  eight  hours  there  will  probably  be  some  jniin 
from  the  blistering  action  of  the  application,  although  no  pustules  will 
have  arisen.  At  about  two  o'clock  in  the  afternoon  a  second  application 
is  made,  the  ointment  being  rubbed  in  with  a  light  hand;  the  ointment 
is  then  allowed  to  remain,  and  its  absorption  is  completed  about  the  third 
day.  In  ordinary  cases  one  such  course  cures  the  patient,  but  in  bad 
cases  it  may  be  necessary  to  repeat  the  treatment  in  six  or  twelve  months. 
In  countries  where  the  sun  is  less  powerful,  the  patient  sits  before  a  fierce 
fire;  or  the  ointment  may  be  rubbed  over  the  swelling  night  and  morning, 
afterwards  covering  it  Avith  oil-skin.  The  full  effect  is  produced  in  a  few 
days,  when  a  mild  ointment  like  spermaceti  is  substituted.     (Stainthorpe.) 

Mercurial  ointments  are  useful  in  erythematous  lupus.     I  have  seen 


196  MERCURY. 

great  advantage  result  from  the  use  of  calomel  ointment  or  black -wash  in 
scrofulous  and  tubercular  lupus  of  children,  and  in  open  scrofulous  sores. 
Scrofulous  sores  that  had  resisted  other  treatment  I  have  often  seen  yield 
speedily  to  the  application  of  calomel  ointment. 

In  tubercular  lupus,  Xayler  advises  touching  the  summit  of  the  tuber- 
cles with  the  solution  of  acid  nitrate  of  mercury,  repeating  the  application 
till  they  are  reduced  to  the  level  of  the  skin,  but  not  deeper,  or  a  scar  will 
result.  Each  application  excites  a  good  deal  of  inflammation  and  pain; 
but  the  pain  may  be  allayed  by  covering  the  spot  with  collodion.  Xayler 
uses  the  mercurial  vapor  bath  in  general  eczema. 

Mercurial  preparations,  especially  black-wash,  are  very  useful  applica- 
tions to  syphilitic  sores.  Thus  mucous  tubercles  soon  yield  to  black-wash. 
Black-wash  is  useful,  too,  for  those  elevated  indurations  occurring  at  the 
anus  of  children,  differing  from  mucous  tubercles,  Ijeing  of  much  larger 
size,  of  irregular  shape,  often  limited  to  one  side,  and  generally  extending 
some  Avay  up  the  rectum.  This  eruption,  which  may  bleed  and  smart 
severely  each  time  a  motion  passes,  often  disappears  but  slowly  under  the 
influence  of  mercury  administered  by  the  mouth,  and  may,  in  spite  of  it, 
continue  increasing  slightly  for  months;  while,  if  kept  constantly  moist 
with  black-wash,  its  removal  may  be  assured  in  ten  days  or  a  fortnight. 
Black- wash  is  very  useful  in  other  syphilitic  sores. 

When  it  is  not  convenient  to  apply  black-wash,  calomel  or  citrine 
ointment  well  rubbed  in  may  be  substituted. 

Calomel,  dusted  over  syphilitic  condylomata,  generally  removes  them. 

Cyanide  of  mercury  in  solution,  in  the  proportion  of  five,  ten,  or  fifteen 
grains  to  an  ounce  of  water,  is  useful  as  a  local  application  to  syphilitic 
rashes  and  sores,  as  those  of  the  throat,  tongue,  anus,  penis,  etc.  For 
sores  on  the  prepuce  or  glans  a  solution  of  five  grains  to  the  ounce  is  gen- 
erally strong  enough,  and  even  this  strength  sometimes  excites  a  good 
deal  of  smarting.  It  should  be  well  rubbed  in  with  a  camel-hair  brush, 
once,  or  at  most  twice  a  day,  carefully  avoiding  the  neighboring  healthy 
tissues.  In  case  of  chancres  it  is  a  good  plan  to  apply  this  lotion  daily, 
or  to  keep  the  sore  moist  with  lint  soaked  in  black-wash.  Mercurial  oint- 
ments rubbed  into  the  skin  of  the  penis  are  often  apt  to  bring  out  a  crop 
of  eczema,  with  considerable  swelling. 

Mercurial  applications  mixed  with  other  substances,  as  tar,  are  very 
useful  in  syphilitic  psoriasis. 

Mercurial  fumigations  are  very  successful  in  syphilis:  calomel,  which 
is  undestroyed  by  heat  or  moisture,  and  gives  constant  results,  is  em- 
ployed. Some  employ  dry  fumigation;  others  maintain  that  the  thera- 
peutic effects  of  mercury  are  increased  by  steam.  This  mode  of  adminis- 
tering mercury  is  considered  the  best  and  surest  way  of  eradicating  syphilis. 
Moreover,  it  affects  the  general  health  less  deleteriously,  disturbing 
neither  the  functions  of  the  stomach  nor  the  intestines.  Ten  to  twenty 
grains  of  calomel  are  used  at  each  fumigation.  The  fumigations  some- 
times produce  so  much  weakness  and  prostration  that  they  cannot  be 
continued.  There  can  be  no  doubt  that  many  cases  of  syphilis,  rebellious 
to  other  treatment,  yield  to  these  fumigations.  Sometimes  only  a  portion 
of  the  body  affected  with  syphilitic  rash  is  sul)jected  to  calomel  fumigation. 

Mercurial  applications,  but  especially  the  mercurial  and  calomel  oint- 
ments, are  rubbed  into  delicate  parts  of  the  skin,  so  as  to  mercurialize  the 
system  by  their  absorption.  This  method  has  the  advantage  of  not  dis- 
ordering the  digestive  canal. 


MERCURY.  197 

Bichloride  of  mercury  has  been  injected  under  the  skin,  and  a  much 
smaller  quantity  aifects  the  system  than  when  administered  by  the  mouth; 
but  this  painful  mode  of  treating  syphilis  is  not  likely  to  become  general. 

At  one  time  the  application  to  the  face  of  mercurial  ointment  or  of 
mercurial  plaster  was  in  vogue  to  prevent  the  pittiiig  of  small-pox.  It  is 
a  question  of  interest  whether  the  mercury  itself  plays  any  part  in  arrest- 
ing the  maturation  of  the  pustules,  or  whether  other  applications  are  not 
as  effective.  A  good  deal  has  been  said  on  each  side  of  the  question,  but 
I  think  that,  since  several  instances  of  very  severe  salivation  have  followd 
this  plastering  in  small-pox,  other  safer  remedies  may  be  used,  perhaps 
not  with  equal  benefit,  yet  with  sufficiently  good  results  to  render  it  de- 
sirable to  employ  them  in  preference  to  the  mercurial  compounds. 

The  exclusion  of  light  and  air  probably  thwarts  the  development  of 
the  pustules  and  prevents  pitting.  The  exclusion  of  air  and  light  can  be 
perfectly  effected  by  collodion  and  india-rubber  dissolved  in  chloroform; 
this,  or  other  means,  should  therefore  be  employed  in  preference  to  mer- 
cury compounds.     {Vide  Nitrate  of  Silver.) 

In  non-syphilitic  ozaena  Trousseau  employs  the  following  snuff- 
powders: — White  precipitate,  4  grains,  sugar  in  fine  powder,  232  grains; 
or  red  precipitate,  4  grains,  sugar  in  fine  powder,  232  grains.  The  nose 
is  first  cleared  by  blowing  it  strongly,  and  then  a  pinch  of  either  powder 
is  snuffed  up  a  i'ew  times  daily  for  a  few  days.  They  quickly  remove  the 
stench,  and  modify  the  state  of  the  mucous  membrane,  though  sometimes 
they  produce  a  rather  powerful  irritating  effect  on  the  mucous  membrane, 
and,  unfortunately,  they  do  not  cure  this  very  intractable  complaint. 

In  the  syphilitic  oztena  of  children  mercurial  ointments,  as  nitrate  of 
mercury  ointment  partially  melted  applied  twice  a  day  after  the  nose  has 
been  well  cleared,  will  arrest  the  secretion,  remove  the  obstruction,  and 
improve  the  condition  of  the  mucous  membrane;  the  child's  health  im- 
proves, for  the  nasal  obstruction  prevents  sucking,  during  which  the 
child  is  unable  to  breathe.  It  is  well  known  that  a  child,  especially  in 
sleep,  breathes  only  through  the  nose,  consequently  the  health  must  suffer 
through  inability  to  sleep  when  the  nasal  passages  are  blocked. 

Half  a  grain  of  bichloride  of  mercury  in  six  ounces  of  water,  applying 
it  every  two,  three,  or  four  hours,  is  a  good  injection  in  gleet. 

Sternberg  shows  that  mercuric  bichloride  is  a  very  powerful  germicide. 
In  regard  to  its  power  to  destroy  the  micrococcus  of  pus,  he  thus  ranks 
it  relatively  to  other  germicidal  agents.  Mercuric  bichloride  active  0.005 
per  cent.,  potassium  permanganate  0.12  per  cent.,  iodine  0.2  per  cent., 
creasote  0.5  per  cent.,  carbolic  acid  1.0  per  cent.,  zinc  chloride  2  per  cent. 
This  germicide  power  has  led  to  the  use  of  weak  mercuric  bichloride  solu- 
tions in  antiseptic  surgery  and  as  a  topical  ajjplication  in  diphtheria. 
Some  use  a  solution  of  1  in  200Q  to  1  in  1000. 

Potassio-mercuric  iodide  is  a  germicide  four  or  five  times  more  pow- 
erful than  mercuric  bichloride.  It  may  be  used  in  the  strength  of  1 
part  in  12,000.     (Levis.) 

]\Iercurial  medicines,  if  administered  at  an  undue  time,  severely  injure 
the  mucous  membrane  of  the  mouth  and  salivary  glands.  The  first 
symptom  is  a  disagreeable  metallic  taste;  the  gums  around  the  teeth 
become  swollen  and  tender,  of  a  dark-  red  color,  the  mucous  membrane 
investing  the  incisor  teeth  being  the  first  affected,  whence  the  inflamma- 
tion spreads;  the  tongue  swells  and  is  thickly  coated,  the  breath  is  exces- 
sively fa'^tid,  the  secretion  from  the  buccal  mucous  membrane  is  aug- 


198  MERCURY. 

men  ted,  and  the  saliva  is  increased  in  quantity  even  to  the  extent  of  one 
or  two  pints  daily.  At  first  the  stiliva  is  richer  than  natural  in  epithelium 
and  solid  constituents,  but  after  a  time  becomes  clearer,  more  watery,  and 
contains  fat  and  mucous  corpuscles.  The  salivary  glands  become  swollen 
and  painful;  at  last  the  inflammation  of  the  mouth  reaches  such  a  point 
that  ulceration  sets  in,  and  progresses  till  large  portions  of  the  gums  and 
cheeks  may  be  destroyed,  the  teeth  becoming  loose,  and  the  bones  of  the 
jaw  carious.  Some  are  much  more  prone  to  become  salivated  than  others; 
weak  persons  are  more  easily  aifected  than  strong;  children  are  rarely 
salivated.  Disease,  too,  influences  the  operation  of  mercury;  for  in  inflam- 
mation it  is  often  well  borne,  while  in  granular  disease  of  the  kidneys  or 
in  scrofula,  patients  are  very  liable  to  become  salivated.  It  is  stated  that 
salivation  has  occurred  three  hours  after  a  dose  of  mercury,  that  it  may 
last  a  few  hours  only,  or  endure  for  several  3'ears,  and  even  disappear  for 
a  time  and  then  return. 

There  are  persons  who  can  never  take  even  a  small  dose  of  mercury 
without  provoking  toothache,  generally  in  a  carious  tooth. 

In  a  certain  stage  of  tonsillitis  the  influence  of  mercury  is  most  marked, 
owing  probably  to  its  absorption  in  the  circulation.  In  quinsy  or  scarla- 
tina, when  the  enlarged  tonsils  almost  meet  and  block  the  passage,  and 
when  the  difficulty  in  swallowing  is  nearly  insuperable,  with  even  danger 
of  suffocation,  at  such  a  crisis  a  third  of  a  grain  of  grey  powder  taken 
every  hour,  greatly  reduces  the  swelling  in  a  few  hours,  and  obviates  the 
distress  and  danger;  and,  even  if  an  abscess  has  formed,  its  maturation 
and  evacuation  appear  to  be  effected  more  quickly. 

The  same  powder,  administered  in  the  same  dose  three  or  four  times 
dailj^,  is  useful  in  mumps,  speedily  relieving  the  swelling  and  pain. 
Probabh",  as  in  the  last  case,  the  drug  acts  only  after  its  absorption. 

The  soluble  preparations  of  mercury  combine  with  the  albuminous 
matters  in  the  mouth,  and  any  j^ortion  left  uncombined  attacks  the 
mucous  membrane,  and  may  excite  in  it  acute  inflammation. 

They  act  in  a  similar  manner  in  the  stomach. 

A  form  of  vomiting  is  sometimes  met  with  in  very  young  children — 
generally  only  a  few  weeks  old — which  yields  in  many  instances  to  grey 
j)Owder  or  calomel,  but  especially  to  grey  powder.  The  chief,  and  to  a 
great  extent  characteristic  feature  of  this  vomiting  is  its  suddenness  and 
instantaneousness;  for  immediately  the  milk  is  swallowed  it  is  forcibly  ex- 
pelled, curdled  or  uncurdled,  apparently  without  any  retching  or  effort  on 
the  part  of  the  child.  The  milk  literally  shoots  out  of  both  mouth  and 
nose.  Diarrhoea  may  exist,  but  more  generally  there  is  constipation. 
This  affection  often  proves  both  obstinate  and  dangerous,  as  all  the  food  is 
ejected,  till  the  child,  reduced  almost  to  a  skeleton,  dies  actually  of  starva- 
tion. At  the  pod  moi'fein  it  often  happens,  either  that  nothing  is  found 
to  account  for  death,  or  the  mucous  membrane  may  be  much  softened, 
and  like  water  arrowroot  in  consistency  and  appearance.  One-third  of  a 
grain  of  grey  powder,  repeated  every  two  or  three  hours,  will  in  many 
instances  quickly  stay  this  vomiting,  which  resists  all  other  remedies.  A 
twelfth  of  a  grain  of  calomel  also  every  two  hours  sometimes  succeeds. 

The  soluble  preparations  act  as  purgatives,  increasing  the  secretion 
from  the  mucous  lining  and  the  contractions  of  the  muscular  coat  of  the 
intestines.  Xot  all,  however,  are  employed  as  purgatives;  and  when  pur- 
gation is  needed,  our  choice  falls  either  on  calomel  or  gre}'  powder;  either, 
being  tasteless,  is  a  useful  preparation  for  children. 


MERCURY.  199 

Most  purgatives  act  more  efficiently  when  given  in  frequent  small 
doses,  at  every  hour;  but  this  does  not  hold  with  calomel.  Moreover,  ac- 
cording to  my  experience,  we  do  not  much  increase  the  purgative  effect 
by  augmenting  the  size  of  a  dose,  a  grain  acting  as  energetically  as 
five  grains.  Again,  where  a  nightly  purgative  is  needed,  calomel  does  not 
answer,  for  the  dose  adequate  to  produce  four  or  five  motions  the  first 
night,  will  act  only  twice  or  three  times  the  second,  and  often  not  at  all 
the  third. 

The  influence  of  mercury  salts  on  the  pancreatic  and  biliary  secretion 
is  still  undecided.  Seeing  the  influence  of  mercury  on  the  salivary  glands, 
some  conceive  it  probable  that  it  exerts  a  similar  influence  on  the  pancretis, 
a  gland  with  a  structure  and  a  secretion  very  similar  to  those  of  the  saliv- 
ary glands. 

Most  opposite  statements  have  been  made  concerning  the  action  of 
mercury  on  the  secretion  of  bile.  From  experiments  on  animals  it  has 
been  concluded,  though  not  without  dissentients,  that  mercury  in  health 
diminishes  the  secretion  of  bile.  In  his  report,  as  secretary  of  the  Edin- 
burgh committee  appointed  to  investigate  this  matter,  the  late  Dr.  Hughes 
Bennett  arrived  at  somewhat  the  same  conclusion.  This  report  states: 
(1)  That  neither  blue  pill,  calomel,  nor  corrosive  sublimate,  aifect  the 
bile  unless  they  purge,  or  impair  the  health,  when  the  quantity  of  bile  is 
diminished.  (2)  That  during  an  attack  of  dysentery,  both  the  solid  and 
fluid  constituents  of  the  bile  are  diminished.  (3)  Purgation  from  any 
cause  lessens  the  amount  of  bile  and  the  proportion  of  its  solid  constitu- 
ents.    (See  Podoph>illum.) 

Kohrig  and  Rutherford  have  re-investigated  this  subject,  and  they 
conclude  that  calomel  does  not  increase  the  secretion  of  bile,  nay,  in  pur- 
gative doses,  it  may  even  decrease  it.  Rutherford  finds  that  bichloride  of 
mercury  does  increase  the  secretion  of  bile. 

Dr.  H.  Bennett's  committee  experimented  on  dogs  regularly  fed.  Rutherford  and 
TJohrig,  on  fasting  dogs,  in  every  instance  tirst  paralyzing  the  animal  with  curare. 
Tliey  first  inserted  a  glass  caniila  into  the  common  bile  d\ict  near  its  junction  with 
the  duodenum;  tlieu  compressed  tlie  gall  bladder  to  fiUtlie  tubewitli  bile,  and  clamped 
the  cystic  duct.  They  then  closed  the  wound  in  the  abdomen,  and  collected  the  bile 
as  it  tiowed  througli  the  canula. 

In  some  experiments  Rutlierford  placed  the  calomel  in  the  duodenum,  unmixed 
with  bile,  in  others  mixed  with  it;  and  in  others  he  administered  the  calomel  by  the 
stomach. 

Yet  the  experience  of  generations  strongly  supports  the  general  con- 
viction that  in  some  diseases  calomel,  as  well  as  other  preparations  of  mer- 
cury, does  increase  the  bile.  Moreover  it  is  not  difficult  to  conceive  that 
in  a  given  disease  mercury  may  set  aside  some  condition  hindering  the 
formation  of  bile,  and  thus  act  as  a  cholagogue,  though  possibly  in  health 
it  may  even  check  this  secretion.  It  is  certain  that  small  doses  of  mer- 
curous  salts  will  restore  color  to  colorless  stools.  Their  efficacy  may  be 
over  and  over  again  tested  in  children,  for  we  often  meet  with  a  child 
that  for  weeks  passes  quite  colorless  stools.  In  some  cases  grey  powder 
will  restore  the  color,  and  this  can  be  repeated  many  times  in  the  same 
patient,  for  it  often  happens  that  some  time  after  the  discontinuance  of 
the  mercury  the  color  again  leaves  the  motions. 

When  given  to  promote  the  secretion  of  bile,  the  common  practice  is 
to  give  a  purgative  dose  for  one  or  two  nights;  but  if  there  is  no  constipa- 
tion there  is  no  need  to  purge,  and  a  small  dose,  say  one-sixth  to  one-half 
grain  of  grey  powder  twice  or  three  times  a  day,  will  answer  better.     The 


200  MERCURY. 

administration  of  small  doses  frequently  is  especially  advantageous  in  cases 
where  the  illness  is  apt  to  recur  frequently  from  slight  and  scarcely  pre- 
ventible  causes,  and  Avhere  the  frequent  employment  of  purgative  doses 
would  favor  after-constipation,  and  produce  depression  and  possibly  sali- 
vation. For  these  reasons  it  is  common  to  hear  highly  practical  doctors 
decry  mercurial  preparations,  whereas  were  they  to  employ  the  minute 
doses  now  recommended  they  would  obtain  the  desired  effect  and  exclude 
the  bad  results  they  fear.  Given  in  the  doses  just  mentioned,  mercurial 
preparations  in  certain  cases  which  I  will  now  indicate  are  signally  useful: — 

I.  A  patient  voids  pale  clayey  stools  and  suffers  from  acidity,  flatu- 
lence, or  vomiting,  occurring  sometimes  only  before  breakfast.  Half  a 
grain  of  grey  powder  given  three  times  a  day  will  often  restore  color  to 
the  stools,  when  the  d3'speptic  symptoms  cease  at  once. 

II.  Small  doses  of  mercury  yield  excellent  results  in  a  form  of  diarrhoea 
common  in  children.  The  child's  health  is  bad;  the  digestion  is  imper- 
fect, generally  with  annoying  flatulent  distention;  and  three  or  four  pale, 
clayey,  pasty,  stinking  motions  are  passed  in  the  day.  A  single  grain  of 
bichloride  dissolved  in  half  a  pint  of  water,  and  a  teaspoonful  of  this  solu- 
tion given  each  hour;  or,  still  better,  one-third  of  a  grain  of  grey  powder 
every  hour  or  two  hours,  will  in  one  or  two  days  limit  the  number  of  the 
stools,  and  restore  their  natural  bilious  color,  even  though  they  have  been 
clay-colored  for  weeks. 

III.  Again,  we  frequently  meet  with  a  case  like  this: —  A  patient, 
generally  of  nervous  temperament,  on  exposure  to  cold,  or  after  fatigue  or 
excitement,  or  even  without  any  discoverable  cause,  feels  sick,  perhaps 
vomits,  has  a  coated  tongue,  and  in  a  few  hou.rs  becomes  jaundiced,  the 
discoloration  sometimes  affecting  only  the  conjunctiva,  in  other  cases  dye- 
ing the  skin  of  the  whole  body  yellow.  The  stools  are  pale  or  colorless. 
The  attack  lasts  three  or  four  days,  and  is  accompanied  by  great  depres- 
sion. The  patient  may  undergo  many  attacks,  so  frequently  indeed,  that 
before  the  discoloration  of  one  attack  has  passed  away,  another  has  begun 
to  assail  him.  Here  one-sixth  or  one-third  of  a  grain  of  grey  powder, 
taken  at  the  very  onset  and  repeated  three  or  four  times  a  day,  allays  the 
sickness,  cuts  short  the  illness,  increases  the  intervals  between  the  attacks, 
and  after  a  time  cures  the  patient,  though  he  may  have  suffered  thus  for 
several  years.  If,  however,  there  is  obstinate  constipation,  a  course  of 
Carlsbad  waters  is  then  sometimes  more  efficacious. 

IV.  The  same  weak  bichloride  of  mercury  solution  of  a  single  grain  in 
ten  ounces  of  water  in  doses  of  a  teaspoonful,  is  very  efficient  in  another 
serious  form  of  diarrhoea  common  in  children.  The  characteristics  of  this 
form  are  very  slimy  stools,  especially  if  mixed  with  blood,  accompanied 
by  pain  and  straining.  The  salient  indication  for  employing  the  bichloride 
is  the  slimy  character  of  the  motions.  Sometimes  the  slime  is  very  tena- 
cious, and,  being  colored  with  blood,  is  described  by  the  mother  as  "  lumps 
of  flesh."  This  affection  may  be  acute,  or  it  may  be  chronic  and  last  for 
months;  but  in  either  case  the  bichloride  cures  with  remarkable  speed 
and  certainty. 

V.  A  similar  treatment  relieves  the  dysentery,  acute  or  chronic,  of 
adults,  provided  the  stools  are  slimy  and  bloody.  A  hundredth  of  a 
grain  of  the  bichloride  given  hourly,  or  every  two  hours,  according  to  the 
severity  of  the  case,  is  generally  sufficient,  rarely  failing  to  free  the  stools 
from  blood  and  slime,  although  in  some  cases  a  diarrhoea  of  a  different 
character  may  continue  for  a  short  time  longer,  requiring  perhaps  other 
treatment  to  control  it. 


MERCURY.  201 

YT.  A  sixtli  of  :i  gi-ain  of  grey  powder  given  liourly  is  of  great  service 
in  infantile  cholera,  characterized  by  incessant  sickness,  with  profuse  and 
almost  continuous  diarrhoea,  very  offensive  and  copious  motions,  watery, 
almost  colorless,  or  of  a  dirty  muddy  aspect.  Under  this  treatment  the 
vomiting  generally  soon  ceases,  and  the  diarrlnea  shortly  afterwards. 
Infantile  cholera  is  an  extremely  fatal  disease,  running  so  rapid  a  course 
that  in  a  very  brief  space  a  child  is  reduced  to  a  death-like  aspect  and  dan- 
gerous condition.  It  is  essential  then  to  check  the  diarrhoea  as  speedily 
as  possible.  In  urgent  cases  a  starch  injection,  with  a  minute  quantity  of 
laudanum,  assists  the  action  of  grey  powder. 

YII.  We  often  see  in  infants  a  chronic  diarrhea,  characterized  by 
watery,  very  offensive,  muddy-looking  or  green-colored  stools,  often  to  the 
nnmber  of  ten  or  twelve  daily.  This  diarrhoea  Avill  generally  yield  to  grey 
powder,  in  doses  of  a  sixth  of  a  grain,  given  at  first  hourly,  and  then 
every  two  or  three  hours,  according  to  the  frequency  of  the  stools. 
Vomiting  is  an  additional  indication  for  this  treatment.  Although  this 
drug  may  check  the  diarrhoea  and  vomiting,  yet,  if  the  disease  has  endured  a 
iong  time,  so  serious  may-be  the  injury  inflicted  on  the  mucous  memljrane 
of  the  stomach,  that  food  can  neither  be  digested  nor  absorbed,  and  the 
child  gradually  wastes  away.  The  appearance  of  thrush  in  the  mouth  is 
an  unfavorable  sign,  as  it  generally  indicates  profound  damage  to  the 
mucous  membrane  of  the  digestive  canal.  So  also  it  is  a  bad  sign  always 
in  the  chronic  diarrhoea  of  children  when  the  stools  change  in  character 
from  time  to  time — now  watery,  then  slimy,  at  another  time  curdy,  and 
at  another  green.  It  is  far  easier  to  cure  a  diarrhoea  when  the  motions 
are  of  a  uniform  character.  In  most  of  these  cases  full  doses  of  nitrate 
of  bismuth  increases  the  curative  action  of  the  mercury. 

It  is  important  to  treat  the  severe  forms  of  infantile  diarrhoea  promptly, 
for  being  generally  inflammatory,  the  mucous  membrane  of  the  large,  and 
even  that  of  the  small  intestine,  soon  becomes  seriously  affected,  the 
mucous  membrane  of  the  large  intestine  extensively  ulcerated  or  consider- 
ably thickened  and  granular-looking,  whilst  the  mucous  membrane  of  the 
small  intestine,  a  part  of  the  tube  less  commonly  affected,  may  be  much 
softened.  It  will  be  readily  understood  that  disease  so  extensive  must 
take  some  time  to  cure. 

Mercury,  as  we  have  seen,  proves  very  serviceable  in  most  of  the  forms 
of  infantile  diarrhoea,  both  acute  and  chronic.  I  have  endeavored  to 
point  out  categorically  the  circumstances  when  one  mercurial  preparation 
is  preferable  to  another.  It  may  be  urged  that,  as  in  both  severe  acute 
and  chronic  diarrhoea  the  same  pathological  conditions  are  found,  the 
same  form  of  mercury  suitable  for  one  case  would  equally  benefit  another. 
But  although  the  pathological  state  is  held  to  be  identical,  still  some 
hitherto  undetected  differences  there  must  be,  either  in  the  nature  of 
the  disease  itself,  or  of  the  part  it  affects;  for  surely  it  requires  a  different 
pathological  condition  to  produce  in  one  case  slimy  stools,  in  another 
watery,  and  in  another  green  curdy  stools.  These  differences  displayed 
in  the  symptoms,  though  at  present  not  discriminated  pathologically, 
require  somewhat  different  treatment.  Hence,  thoiigh  in  each  kind  of 
diarrhoea  all  forms  of  mercury  are  useful,  it  is  found  that  in  some  cases 
bichloride  of  mercury  is  greatly  to  be  preferred,  and  in  other  cases  grey 
powder.  In  the  treatment  of  chronic  diarrhoea,  mercurial  preparations 
are  often  required  for  many  days,  and  it  frequently  happens  that,  though 
they  alter  the  character  and  lessen  the  frequency  of  the  motions,  yet  the 


202  MERCURY. 

diarrhcea  may  persist,  and  may  require  for  its  cure  other  remedies,  like 
lime,  arsenic,  and  nux  vomica.  In  the  treatment  of  chronic,  as  well  as 
in  that  of  acute  diarrhoea,  too  much  attention  cannot  be  paid  t)otli  to  the 
quality  and  quantity  of  the  food.  Acute  diarrhoea  is  often  aggravated, 
and  made  chronic,  by  over-feeding;  a  short  time  after  eacli  meal  the  child 
is  violently  purged,  and  the  mother  seeing  it  wasting  rapidly  is  apt  to 
think  she  can  sustain  her  child  by  giving  as  much  food  as  possible;  Ijut 
it  must  be  borne  in  mind  that  digestion  is  greatly  impaired,  so  that  but 
little  food  is  digested;  the  excess,  lodging  in  the  intestinal  canal,  under- 
goes decomposition,  and,  acting  as  an  irritant,  increases  the  disease.  Not 
only  should  the  quantity  of  food  be  small,  but  it  should  be  given  fre- 
quently in  very  small  portions.  It  is  also  important  to  clothe  the  child 
warmly,  and  to  put  a  flannel  roller  round  the  belly.  In  most  forms  of 
diarrhoea  in  children  I  am  satisfied  that  it  is  wiser  to  cut  off  milk  and  sub- 
stitute some  artificial  food  like  Nestle's,  Savory  and  ]\Ioore's,  Mellin's,  or 
Robinson's  prepared  barley,  etc. 

There  is  a  form  of  diarrhcjea,  in  which  the  child  passes  large,  acid, 
offensive,  curdy  stools,  evidently  consisting  of  decomposing  curds.  Mer- 
curial preparations,  and,  indeed,  the  other  usual  remedies  for  diarrhcpa, 
are  of  little  avail  in  this  form  of  diarrhoea,  which  is  best  treated  by  with- 
holding milk  entirely  and  substituting  animal  food  or  an  artificial  food  of 
the  kind  just  referred  to. 

The  chronic  diarrhoea  of  adults,  independent  of  serious  organic  change 
of  the  intestines,  with  watery  pale  stools,  often  yields  to  the  hundredth  of 
a  grain  of  corrosive  sublimate  every  two  or  three  hours.  The  same  treat- 
ment answers  sometimes  in  the  diarrhoea  of  typhoid  fever  and  phthisis. 

With  one-third  of  a  grain  of  grey  powder  three  or  four  times  a  day,  a 
thickly-coated  creamy  tongue  occurring  in  dyspepsia,  in  the  coarse  of 
chronic  disease,  or  in  early  commencement  of  convalescence  from  an 
acute  illness,  will  generally  rapidly  get  clean,  with  simultaneous  improve- 
ment of  the  appetite  and  digestion,  and  removal  of  disagreeable  taste  in 
the  mouth.  If  thex'e  is  constipation,  then  it  is  better  to  give  haM  a  grain 
of  calomel  with  three  grains  of  extract  of  hyoscyamus  repeated  for  three 
nights.  The  first  pill  generally  purges  twice  or  thrice,  the  second  less, 
and  the  third  not  at  all.  Grey  powder  should  be  given  if  there  is  either 
diarrhoea  or  tendency  to  it,  for,  besides  its  effect  on  the  tongue  and  stom- 
ach, it  will  generally  control  the  diarrhoea,  at  the  same  time  restoring  their 
natural  color  to  the  motions,  if  too  light  or  too  dark. 

With  the  exception  of  the  sulphide,  all  mercury  compounds  enter  the 
blood,  and  are  employed  in  a  variety  of  diseases  on  account  of  their  action 
on  distant  organs. 

Small  doses  of  corrosive  sublimate  increase  the  weight  of  healthy 
men  and  animals ;  increasing  also  their  red  corpuscles.  Mercury  given 
in  excess  decreases  the  red  corpuscles.  In  small  doses  in  simple  ana?mia, 
the  corpuscles  increase  for  about  fourteen  days,  when  a  slight  reduction 
follows.  The  haemoglobin  increases  till  the  twenty-fourth  day,  and  then 
falls  again.  The  haemoglobin  increases  in  greater  proportion  than  the 
corpuscles.  In  syphilis  accompanied  by  ansemia,  mercury  in  small  doses 
increases  the  red  corpuscles  and  their  haemoglobin,  and  diminishes  the 
white  corpuscles. 

The  prolonged  and  undue  employment  of  mercury  produces  serious 
mischief,  the  body  wastes,  the  blood  becomes  much  impoverished,  and 
"  mercurial  fever  "  may  be  induced,  sometimes  accompanied  by  pustular 


MERCURY.  203 

or  vesicular  eruptions.  A  rise  of  temperature  occurs  with  sensation  of 
heat,  thirst,  loss  of  appetite,  nausea,  vomiting,  purging,  sometimes  bloody- 
stools.  In  mercurial  tremors  weakness  in  the  upper  extremities  is  first 
noticed,  then  voluntary  movements  begin  to  lack  their  usual  precision, 
and  soon  slight  tremors  set  in,  and  gradually  increase  in  severity  and 
extent  till  the  whole  body  becomes  affected,  the  legs  being  attacked  before 
the  trunk.  These  tremors  are  easily  excited,  cannot  be  controlled,  and 
persist  for  some  time.  In  severe  cases  almost  every  part  of  the  body  is 
affected  by  severe  spasmodic  movements,  so  that  respiration  is  spasmodic, 
and  the  sufferer  may  be  unable  to  walk,  talk,  or  masticate.  There  may 
be  neuralgic  pains ;  loss  of  memor}',  headache,  delirium,  and  even  con- 
vulsions may  occur.  Salivation  is  sometimes  absent,  for  the  mode  of 
poisoning  greatly  influences  the  effect  of  mercury,  inhalation  generally 
jaroducing  tremors,  inunction  producing  salivation.  Inunction,  however, 
has  produced  tremors.  Complete  recovery  generally  takes  place,  provided 
the  patient  is  removed  from  the  influence  of  mercury  before  the  disease 
has  greatly  advanced.  The  nervous  symptoms  are  usually  slowly  pro- 
duced, but  they  may  occur  after  only  a  short  exposure  to  mercurial  vapor, 
for  Dr.  Christison  narrates  a  case  where  one  night's  exposure  to  the 
vapor  from  a  pot  of  mercury  on  a  stove  produced  tremor  which  lasted 
for  life. 

The  treatment  of  mercurial  poisoning  consists  in  the  use  of  simple  or 
sulphurous  baths,  and  of  iodide  of  potassium.  The  influence  of  iodide  of 
potassium  on  mercury  in  the  system  has  been  spoken  of  elsewhere. 

Mercury  is  preeminently  useful  in  syphilis.  The  following  I  believe 
fairly  represents  the  views  now  most  generally  held : 

That  it  is  good  in  both  jnimary  and  secondary  syjihilis. 

That  it  is  of  use  in  the  treatment  of  the  hard  chancre  only,  and  does 
harm  in  the  soft  chancre. 

That  by  the  aid  of  mercury  the  hard  chancre  is  more  speedily  cured, 
and  the  patient  is  less  liable  to  secondary  symj^toms,  which,  when  they 
do  occur,  are  milder  in  character. 

That  most  forms  of  secondary  syphilis  yield  quickly  to  mercury. 

The  following  propositions  are  extracted  from  the  admirable  lectures 
by  Mr.  Jonathan  Hutchinson,  to  whom  medical  science  is  in  so  many 
ways  indebted : — 

"  That  mercury  is  probably  a  true  vital  antidote  against  the  syphilitic 
virus,  and  that  it  is  capable  of  bringing  about  a  real  cure. 

"  That  in  practice,  a  good  many  cases  are  really  cured  by  mercury ; 
the  cure  being  proved  by  the  restoration  to  good  health,  and  in  some 
cases  by  renewed  susceptibility  to  contagion. 

"  That  the  probability  of  cure  depends  upon  the  stage  of  develop- 
ment attained  by  the  disease  when  the  remedy  is  resorted  to,  and  upon 
the  perseverance  with  which  it  is  used. 

"  That  in  order  to  secure  the  antidotal  efficacy  of  mercury  against 
syphilis,  it  is  desirable  to  introduce  a  considerable  quantity  into  the 
system,  and  to  protract  its  use  over  a  very  long  time. 

"  That  ptyalism  and  other  evidences  of  the  physiological  action  of 
mercury,  so  far  from  being  beneficial,  are,  if  possible,  to  be  care- 
fully avoided,  since  they  prevent  the  sufficiently  prolonged  use  of  the 
remedy. 

*"  That  in  cases  in  which  the  patient  shows  an  idiosyncrasy  peculiarly 


204  MERCURY. 

susceptible  to  mercury,  the  indication  is  to  reduce  the  dose,  rather  tlian 
to  omit  the  drug. 

"  That  it  is  impossible  to  begin  tlie  administration  of  mercury  too 
soon,  and  that  it  should  be  resorted  to  without  loss  of  time  in  all  cases 
in  which  a  chancre  shows  a  tendency  to  indurate. 

'*  That  many  cases  of  indurated  chancre,  treated  early  by  mercury, 
never  show  any  of  the  characteristic  symptoms  of  the  secondary  stage. 

"  That  in  other  cases  of  mercurial  cure  of  the  chancre,  in  which  yet 
secondary  symptoms  do  occur,  they  are  usually  milder  than  if  allowed 
to  develop  without  specific  treatment. 

"  That  when  mercury  does  not  wholly  abrogate  the  secondary  stage 
it  exhibits  a  remarkable  jjower  in  delaying  it. 

"  That  delayed  outbreaks  of  secondary  syphilis  are  to  be  regarded 
rather  as  proof  that  the  administration  had  not  been  suflticiently  perse- 
vering, than  that  the  remedy  was  not  efficient. 

"  That  it  is  probable  that  the  risk  of  tertiary  symptoms,  is  in  ratio 
with  the  severity  and  prolonged  duration  of  the  secondary  stage. 

"That  there  are  some  grounds  for  believing  that  the  tertiary  symp- 
toms of  syphilis  are  both  less  frequent  and  less  severe  in  those  who  have 
been  efficiently  treated  by  mercury,  than  in  others. 

"  That  mercury,  cautiously  given,  does  not,  in  a  great  majority  of 
cases,  do  any  injury  to  the  general  health,  and  that  its  local  inconven- 
iences may  usually  be  prevented. 

"  That  the  doctrine  of  the  re-id  antidotal  character  of  mercury  in 
respect  to  syphilis,  ought  to  lead  to  much  more  prolonged  administration 
of  it,  with  the  hope  of  destroying  utterly  all  lingering  germs  of  the 
malady. 

"  That  most  collected  statistics  as  to  the  duration  of  treatment  and 
freedom  from  relapse,  are  misleading  and  worse  than  useless  because 
usually  the  treatment  was  far  too  short  to  be  effectual. 

'■  That  it  has  not  yet  been  proved  that  there  are  any  special  forms  of 
syphilitic  disease  in  which  mercury  ought  to  be  avoided,  although,  as  a 
rule,  it  is  acknowledged  that  it  must  be  used  with  more  caution  in  all 
forms  which  are  attended  with  ulceration  than  in  others. 

"  That  iodide  of  potassium  possesses  little  or  no  efficacy  against  either 
the  primary  or  secondary  forms  of  syphilis. 

"  That  the  efficacy  of  mercury  is  often  most  signally  proved  in  cases 
which  have  utterly  resisted  the  action  of  iodide  of  potassium. 

"  That  it  does  not  much  matter  whether  the  mercury  is  given  by  the 
mouth,  by  inunction,  or  by  the  vapor  bath,  provided  that  whatever 
method  is  selected,  care  is  taken  to  avoid  salivation,  purging,  etc. 

"  That  the  doses  usually  resorted  to  for  internal  administration,  are 
for  the  most  part  too  large,  and  thus  often  necessitate  a  premature  dis- 
continuance of  the  remedy. 

"  That  if  one  method  of  administration  does  not  proceed  satisfac- 
toriljf,  another  should  be  tried;  and  that  in  no  case  of  difficulty  should 
the  vapor  bath  be  forgotten." 

Many  other  writers  agree  with  Mr.  Hutchinson.  Dr.  Keyes  of  Xew 
York  recommends  the  unremitting  use  of  mercury  for  at  least  two  years, 
and  sometimes  longer,  in  small  doses  incapable  of  producing  physiological 
effects.     Dr.  Keyes  entertains  the  belief  that  syjdiilis  can  be  eradicated. 

Most  of  the  forms  of  congenital  syphilis  of  children  succumb  to  mer- 


MERCURY.  205 

cury  with  singular  rapidity.  It  is  a  common  practice  to  give  to  children 
small  doses,  as  a  quarter  of  a  grain  of  gray  powder,  and  to  add  to  it  a 
small  portion  of  Dover's  powder  to  prevent  relaxation  of  the  bowels.  But 
I  am  convinced  that  much  larger  doses  of  gray  powder  are  more  beneficial, 
and  remove  the  disease  far  more  quickly,  and  succeed,  indeed,  where  the 
smaller  dose  fails.  Thus  one,  or  ^ven  two,  grains  of  gray  powder  may 
be  given  three  times  a  day,  unguarded  with  opium,  for  it  is  the  rarest 
thing  for  even  these  doses  to  purge ;  nay,  if  any  diarrhoea  exists,  a  not 
imcommon  complication,  these  doses  check  it.  Moreover,  they  may  be 
continued  for  a  considerable  time,  till  every  symptom  has  vanished,  witli- 
out  producing  any  of  the  toxic  effects  of  the  drug.  As  a  rule,  however, 
one  grain  of  gray  powder  thrice  daily  is  sufficient.  Those  comparatively 
rare  forms  of  congenital  disease,  where  the  periosteum  is  affected,  usually 
near  the  articulation  of  some  of  the  long  bones,  yield  best  to  iodide  of 
potassium,  though,  as  far  as  my  experience  goes,  it  is  still  necessary 
in  most  cases  to  resort  to  mercury  to  remove  the  other  evidences  of 
syphilis. 

While  admitting  the  validity  of  these  views,  it  is  necessary  to  say  that 
sometimes  syphilitic  patients  are  apparently  completely  cured  without 
mercury,  by  mere  general  treatment  tending  to  improve  the  health ;  and 
further,  if  the  health  is  kept  in  good  order,  the  secondary  symptoms  will 
be  of  a  mild  character.  Oases  of  syphilis  occur  which  are  entirely  un- 
influenced by  mercury,  and  are  curable  only  by  diligent  attention  to 
those  hygienic  circumstances  which  mend  the  general  health. 

When  other  means  fail,  mercurial  fumigations,  with  steam,  often 
cure  certain  obstinate  syphilitic  rashes. 

The  firmest  believers  in  the  effica.cy  of  mercury  in  syphilis,  are  unani- 
mously agreed  that  to  give  it  in  quantities  sufficient  to  produce  saliva- 
tion, is  not  only  undesirable,  but  pernicious;  yet  it  appears  that  those 
preparations  which  salivate  quickest,  manifest  the  greatest  power  over 
the  disease,  and  hence  the  metallic  and  mercurous  preparations,  as  gray 
powder  and  calomel,  are  preferred  by  some  to  the  mercuric,  as  corrosive 
sublimate. 

To  prevent  or  to  mitigate  an  attack  of  sick  headache,  it  is  a  common 
and  often  successful  practice,  to  take  a  mercurial  purge,  generally  in  the 
form  of  a  blue  pill. 

For  further  suggestions  as  to  the  employment  of  mercury  in  this 
troublesome  affection,  the  reader  is  referred  to  the  section  on  podo- 
phyllum. 

It  was  formerly  thought  that  mercury  salts  were  endowed  with  the 
power  of  controlling  inflammation,  and  to  this  end  they  were  constantly 
given,  even  to  salivation ;  now,  however,  their  use  under  such  circumstan- 
ces is  much  less  general.  Bichloride  of  mercury  certainly  appears  to  be 
of  great  use  in  iritis  and  inflammations  of  the  deep-seated  parts  of  the  eye; 
and  in  other  inflammations,  especially  of  the  serous  membranes,  it  is  prob- 
ably of  service  in  checking  the  inflammation  and  jjromoting  the  absorji- 
tion  of  effusfcd  products. 

According  to  very  high  authorities,  among  whom  may  be  mentioned 
Dr.  Parkes,  small  doses  of  calomel  may  be  very  beneficially  given  in  ty- 
phoid fever.  It  should  be  given  at  the  commencement,  some  think  it 
useless  after  the  ninth  or  tenth  day.  It  is  considered  to  lessen  the 
height  of  the  fever,  to  shorten  its  course,  to  render  the  intestinal  de- 
rangement much  milder,  and  to  check  the  diarrhoea.     Some  push  the 


206  COPPER. 

medicine  till  the  gums  are  slightly  touched ;  but  this  practice,  not  only 
unnecessary,  but  harmful,  should  be  carefully  avoided. 

Calomel  administered  several  times  a  day  is  strongly  recommended 
as  a  i^owerful  diuretic  in  cardiac  dropsy,  and,  according  to  some  'writers, 
also  in  renal  droj)sy.  It  has  been  recommended  in  cirrhotic  ascites. 
Sometimes  its  effects  are  only  temporary. 

Mei-cury  remaius  a  long  time  in  fhe  body,  and  may  accumulate,  so  it 
is  said,  in  globules  in  the  cancellous  structures  of  bone. 

Mercury  salts  are  to  some  extent  eliminated  by  the  urine,  by  the  mu- 
cous membrane  of  the  intestines,  and  with  the  bile;  indeed,  it  has  been 
found  in  every  secretion,  physiological  and  pathological. 


PREPARATIONS   OF   COPPER. 

Applied  to  the  unbroken  skin,  the  soluble  salts  of  copjoer  produce  no 
visible  effect.  They  unite  with  the  soluble  albuminous  substances  on 
sores,  forming  an  insoluble  albuminate,  which  coats  the  surface,  and,  in 
an  imperfect  manner,  may  take  the  place  of  the  lost  cuticle.  The  thin 
Ijellicle  thus  formed  protects  the  delicate  structures  from  the  air,  and  the 
substances  floating  in  it,  and  so  jn'omotes  the  healing  process.  Like  many 
other  metals  these  salts  condense  the  structures  and  constringe  the  blood- 
vessels, and  so  lessen  the  supply  of  blood  to  the  part,  and  may  even  arrest 
hfemorrhage  from  the  smaller  vessels.  They  act  as  irritants  to  the  deli- 
cate tissues,  producing  slight  inflammation,  with  some  smarting  pain. 

To  arrest  bleeding,  and  as  an  irritant  to  indolent  sores,  the  sulphate 
is  most  employed,  either  in  stick  or  solution,  or  as  an  ointment. 

Indolent  forms  of  impetigo,  after  resisting  the  more  usual  ajjplica- 
tions,  will  sometimes  yield  to  sulphate  of  copi^er. 

In  tinea  tarsi  the  solid  sulphate  may  be  rubbed,  often  with  conspicu- 
ous advantage,  along  the  edges  of  the  eyelids,  the  eyelashes  having  been 
previously  cut  off  closely,  and  the  scabs  carefully  removed.  Indeed,  in 
every  case  where  slight  stimulation  is  required,  this  salt  may  be  used. 
Milder  in  its  action  than  nitrate  of  silver,  it  excites  much  less  pain. 

The  soluble  snlts  combine  in  the  mouth  with  the  liquid  albuminous 
substances  of  this  cavit}',  and  precipitate  them  more  or  less  completely; 
but  if  used  in  quantity  more  than  sufticient  to  do  this,  the  mucous  mem- 
brane itself  is  attacked  in  a  manner  altogether  similar  to  the  abraded  skin. 
These  salts  possess  a  metallic  styptic  taste. 

The  sulphate  in  the  solid  form  may  be  applied  with  advantage  to 
the  spots  of  jjsoriasis,  simple  or  specific,  or  to  indolent  sores  aff'ecting 
the  tongue.  Painted  in  solution  over  the  edges  of  the  gums  in  ulcera- 
tive stomatitis,  it  generally  quickly  heals  tlie  ulcerated  surfaces,  but  on 
the  wliole  dried  alum  is  to  be  preferred. 

A  weak  solution  of  this  salt  painted  over  the  mucous  membrane  will 
remove  the  white  curdy-looking  coating  of  thrush,  and  prevent  its  re- 
newal. 


ZINC.  207 

The  soluble  salts  in  the  stomach  behave  in  the  same  manner  as  in 
the  mouth,  and  if  taken  in  large  quantities,  act  as  jJowerful  irritant 
poisons. 

These  salts  are  emetic;  the  sulphate,  being  speedy, and  mostly  effect- 
ual, is  not  unfrequently  i^rescribed.  A  good  Avay  to  give  this  salt  as  a 
vomit  is  to  administer  it  in  small  and  frequently-repeated  doses.  It  gen- 
erally produces  one  copious  evacuation,  neither  purging  nor  producing 
much  nausea  or  prostration.  It  is  supposed  to  exert  an  especial  action 
on  the  larynx,  hence  it  is  sometimes  given  in  croup,  and  when  it  is  nec- 
essary to  expel  any  obstructive  substances  from  the  glottis  by  the  me- 
chanical efforts  of  vomiting. 

Copper  salts,  like  zinc  salts,  alum,  mustard,  common  salt,  warm  water 
and  bitter  infusions,  act  topically  on  the  stomach,  and  but  slightly 
through  its  direct  action  on  the  centre  of  vomiting  after  its  absorption 
into  the  blood. 

In  moderate  doses  the  salts  are  astringent  to  the  mucous  membrane  of 
the  intestines.  The  sulphate,  administered  either  by  the  mouth  or  by  in- 
jection into  the  rectum,  is  often  effectual  in  staying  severe  chronic  or  acute 
diarrhoea,  whether  or  not  depending  on  serious  organic  disease. 

Copper  salts,  taken  for  a  considerable  time  in  small  quantities,  are 
said  to  give  rise  to  a  condition  not  unlike  that  produced  by  lead  ;  for 
example,  colic,  with  alternating  constipation  and  diarrhoea,  and,  it  is  even 
said,  paralysis  of  the  upper  extremities,  undistinguisbable  from  that  of 
lead. 

Salts  of  copper  find  their  way  into  the  blood,  existing  there  probably 
as  albuminates. 

Drs.  Levi  and  Barduzzi  find  that  small  doses  of  sulphate  of  copper 
promote  assimilation,  and  increase  strength  and  "  flesh"  in  man  and  ani- 
mals. They  are  used  with  benefit  in  erythema,  ecthyma,  eczema,  scrof- 
ula, tuberculosis.  Copper,  therefore,  appears  to  act  physiologically  and 
therapeutically  much  like  arsenic,  and,  like  it,  should  be  taken  with,  or 
soon  after,  food. 

Copper  salts  have  been  given  in  cholera  and  epilepsy. 

Solutions  of  the  sulphate  are  employed  in  gonorrhoea,  gleet  and  leu- 
corrhoea. 

Copper  is  eliminated  both  by  the  urine  and  fasces. 


PREPARATIONS   OF   ZINC. 

The  members  of  this  group  are  employed  in  various  ways  as  external 
applications. 

Even  in  dilute  solutions  chloride  of  zine  destro3^s  low  organized  forms, 
and  is  thus  a  disinfectant  and  antiseptic. 

Their  common  action  is  astringent  and  irritant :  but  on  account  of 
their  different  degrees  of  solubility,  their  varying  affinity  for  water,  and 
perhaps  for  the  tissues,  the  several  members  of  this  group  manifest  these 
properties  in  unequal  degrees. 

The  chloride  and  iodide,  from  their  high  diffusion-power  and  great 
affinity  for  water,  are  the  most  energetic;  yet  even  these  remain  almost 
inert  on  the  skin,  unless  the  cuticle  is  first  removed,  when  they  perme- 


208  ZINC. 

ate  tlie  tissues,  and  destroy  tliem  for  a  considerable  depth.  The  chloride 
at  first  produces  a  sensation  of  Avarmth,  which  increases  to  a  burning 
pain,  lasting  seven  or  eight  hours,  by  which  time  the  tissues  are  destroyed, 
and  a  white  eschar  is  formed,  which  separates  in  from  seven  to  twelve 
days.  The  chloride  and  iodide,  as  Ave  have  just  said,  have  hitherto  been 
regarded  as  the  most  energetic  salts  of  this  series,  but  recentlv  Mr.  ^lar- 
shall,  of  University  College,  has  shown  by  experiments  that  the  nitrate 
penetrates  deeper  than  the  chloride,  destroying  the  tissues  to  a  greater 
depth,  and,  according  to  the  same  authority,  possesses  the  further  advan- 
tage of  producing  less  pain  than  the  chloride.  These  three  preparations, 
but  especially  the  chloride,  are  applied  to  nsevi,  warts,  condylomata,  the 
skin  affected  Avith  lupus,  and  the  tissues  of  syphilitic  ulcers. 

The  sulphate  having  a  loAvcr  diffusion-poAver,  its  action  is  much  more 
superficial.  In  common  AA-itli  the  other  soluble  salts  of  zinc,  it  forms  an 
insoluble  compound  Avith  albumen,  and  by  virtue  of  its  astringency  con- 
denses the  tissues,  and  contracts  the  blood-vessels.  As  a  stimulant  aiul 
astringent  it  lessens  the  secretions,  and  promotes  healtliier  groAvth  of  ill- 
conditioned,  free-secreting  sores  or  eruptions.  In  common  Avith  the  chlo- 
ride it  is  used  as  an  injection  in  gonorrhoea  or  gleet. 

A  grain  or  tAvo  grains  of  chloride  of  zinc  dissoh'ed  in  a  pint  of  Avater, 
and  a  little  of  this  solution  injected  hourly  during  the  day,  is  often  use- 
ful in  gonorrho'a,  if  treated  at  its  very  beginning,  removing  the  disease  in 
twenty-four  to  forty- eight  hours.  Rest,  if  possible,  should  be  observed; 
but  this  is  not  indispensable.  If  the  frequent  injection  causes  any  pain  in 
the  testicles,  they  should  be  suspended  and  frequently  fomented  with  hot 
water;  if,  notAvithstanding,  the  pain  continues  and  the  SAvelling  increases, 
the  injection  must  be  employed  less  often. 

A  solution  so  weak  as  the  one  recommended  is  no  better,  it  may  be 
said,  than  simple  Avater;  but  the  fact  is,  simple  AA-ater  does  not  cure 
with  anything  like  the  same  rapidity.  If  some  of  this  solution  is  taken 
into  the  mouth,  and  retained  there  a  fcAv  seconds,  it  Avill  produce  a  de- 
cided roughness  of  the  mucous  membrane;  noAV,  if  the  solution  is  strong 
enough  to  affect  the  mucous  membrane  of  the  mouth,  it  can  certainly 
influence,  in  at  least  an  equal  degree,  a  similar,  but  more  sensitive,  struct- 
ure in  the  urethra. 

The  carbonate  and  oxide  are  insoluble,  or  but  very  slightly  soluble,  in 
the  animal  fluids  ;  and  as  these  salts  i^ossess  no  affinity  for  Avater,  their 
action  on  the  tissues  is  very  Aveak.  They  are,  hoAvever,  slightly  astringent, 
and  are  useful  on  account  of  this  property,  in  ointment,  or  in  poAvder. 
The  ointment  of  the  oxide  is  used  as  a  mild  stimulating  ap2:»lication  in 
eczema  and  impetigo,  when  mflammation  having  suljsided  the  raAV  surface 
is  left  in  an  indolent  state,  Avitli  very  little  disposition  to  heal.  Both  the 
oxide  and  carbonate  are  used  as  dusting  poAvder,  and  are,  perhaps,  the  best 
poAvders  for  this  purpose;  but,  as  a  rule,  greasy  applications  are  preferable. 
In  inflamed  conjunctiA-a,  a  weak  solution  of  the  sulphate  dropped  into  the 
eye  several  times  a  day  is  often  very  useful.  The  same  salt  is  occasionally 
employed  as  a  gargle  in  relaxed  sore-throat,  and  is  sometimes  added  to 
alum  injections  for  leucorrluea. 

The  more  soluble  preparations  possess  a  metallic  styptic  taste.  Xone 
are  employed  in  diseases  of  the  mouth.  The  chloride  has  been  used  to 
destroy  the  exposed  painful  pulp  of  decayed  teeth. 

The  carbonate  in  large  doses  produces  some  nausea  and  vomiting;  but 
a  full  dose  of  the  sulphate  acts  much  more  speedily,  is  a  safe  emetic,  pro- 


ZINC.  209 

ducing  little  prostration  or  nausea,  and  generally  empties  the  stomach  in 
one  complete  evacuation.  It  is,  therefore,  the  best  emetic  in  cases  of 
poisoning,  being  far  preferable  to  the  slow  and  unsure  action  of  ipecacu- 
anha. It  maybe  employed  as  an  emetic  in  bronchitis  or  croup;  in  bron- 
chitis, to  expel  the  mucus  from  the  bronchial  tubes;  in  croup,  the  false 
membrane  from  the  larynx ;  but  other  emetics  are  mostly  preferred.  The 
suljjhate  may  be  employed  as  an  emetic,  or  in  doses  short  of  the  induction 
of  vomiting,  in  painful  affections  of  the  stomach,  dependent  on  chronic 
inflammation  of  the  mucous  membrane.  Injected  into  the  blood,  the 
sulphate  excites  vomiting.  It  acts,  however,  chiefly  by  its  topical  action 
on  the  stomach. 

On  account  of  its  slight  solubility,  the  oxide  exerts  but  slight  action 
on  the  stomach,  little  being  dissolved  unless  much  acid  is  present.  Like 
most  other  metallic  preparations,  the  oxide  and  sulphate  of  zinc  are  useful 
in  acute  or  chronic  diarrhoea. 

Dr.  Brackenridge  strongly  recommends  oxide  of  zinc  in  two  to  foui 
grain  doses  every  three  hours  in  the  diarrhoea  of  children. 

The  chloride  is  a  corrosive  poison.  The  sulphate,  on  account  of  its 
astringency,  like  most  other  metallic  salts,  may  be  employed  in  diarrhoea. 
Its  action  must  take  effect  on  the  upper  part  of  the  canal,  since  the  por- 
tion escaping  absorption  must  be  speedily  converted  into  an  inert  sulphide. 
The  stomach  may  become  habituated  to  the  ingestion  of  very  large  doses  of 
the  sulphate,  to  the  extent  even  of  forty  grains  thrice  daily,  without  ob- 
vious bad  results,  or  without  inducing  either  nausea  or  vomiting,  or  appar- 
ently any  alteration  in  the  mttcous  membrane  of  the  digestive  canal.  As 
it  has  been  shown  that  stiperficial  itlceration  of  the  stomach  may  be  pro- 
duced, the  prolonged  employment  of  sitcli  doses  is  imprudent. 

Zinc  colic  has  been  described  with  symptoms  including  constipation, 
vomiting,  prostration,  with  disagreeable  taste  in  the  mouth. 

Zinc  finds  its  way  into  the  blood,  and  exists  there  probably  as  an  albu- 
minate. 

The  oxide  and  sulphate  have  been  employed  w^lth  advantage  in  epi- 
lepsy and  whooping  cough.  In  bromide  of  potassium  we  now  possess  a 
better  remedy  for  epilepsy. 

Sulphate  of  zinc  is  often  very  useful  in  chorea.  Like  tartar  emetic,  it 
sticceeds  best  when  given  in  doses  stifiicient  to  produce  nausea,  or  even 
vomiting,  daily.  To  effect  this,  however,  the  dose  must  be  rapidly  in- 
creased, sometimes  to  the  extent  of  two  grains  every  two  hottrs  daily,  and 
it  is  astonishing  how  much  of  this  drug  can  be  borne,  for  I  have  given 
fifteen  and  sometimes  twenty-two  grains  eyery  two  hours  withotit  produc- 
ing nausea.  Thus  administered  this  salt  often  effects  striking  improve- 
ment, but  these  heroic  doses  after  a  time  excite  pain  at  the  pit  of  the  stom- 
ach with  loss  of  appetite,  and  when  this  happens,  another  emetic,  like 
tartar-emetic,  may  be  substituted.  When  given  to  excite  nausea,  it  is  a  good 
plan  to  administer  a  dose  before  breakfast. 

It  is  a  noteworthy  fact  that  most  emetics  are  useful  in  chorea.  Do 
they  act  by  exciting  the  physiological  state  of  nausea,  or  by  their  opera- 
tion on  the  nervous  centres  through  which  emetics  produce  nausea  ?  As 
improvement  occttrs  in  many  cases  independently  of  the  induction  of  nau- 
sea, the  latter  suggestion  is  probably  the  more  feasible. 

Zinc  salts  are  reputed  to  be  powerful  "  nervine  tonics,"  a  somewhat 
vague  expression,  meant,  I  suppose,  to  imply  that  they  promote  the  nu- 
14 


210  ANTIMONY. 

trition  of  the  nervous  system,  and  some  authorities  attribute  to  this  prop- 
erty the  influence  of  these  salts  in  chorea.  In  certain  forms  of  hysteria 
zinc  salts  are  useful,  especially   in  the  shape  of  the  valerianate. 

These  substances  are  reputed  to  be  antispasmodic.  "When  they  pro- 
duce nausea  no  doubt  they  indirectly  act  thus  ;  but  it  is  doubtful  whether 
non-emetic  doses  are  efficient  antispasmodics. 

The  oxide  in  two  to  four  grain  nightly  doses  often  controls  profuse 
colliquative  sweating.  It  is  said  also  to  check  the  profuse  secretion  from 
the  bronchial  mucous  membrane  in  some  forms  of  bronchitis. 

Dr.  Hammond  recommends  oxide  of  zinc,  in  two  to  five  grain  doses, 
for  nervous  headache. 

This  metal  does  not  become  fixed  in  the  body,  nor  does  it,  like  lead  or 
mercury,  produce  chronic  affection.  Zinc  salts  are  eliminated  from  the 
body  less  rapidly  than  some  other  metals,  passing  out  in  small  quantities 
only  by  the  urine.  It  has  been  asserted  that  very  little  of  the  salts  pass  into 
the  blood,  which  may  be  true  ;  but  the  fact  that  the  chief  part  may  be  re- 
obtained  from  the  faeces  is  no  proof  of  this  statement,  as  zinc,  like  many 
other  metals,  is  probably  excreted  by  the  mucous  membrane  of  the  intes- 
tines, and  with  the  bile. 

Zinc  chloride,  even  in  dilute  solution,  is  a  powerful  poison  to  low  forms 
of  life.  Hence  it  is  antiseptic  and  disinfectant,  and  is  used  to  destroy  the 
contagiousness  of  typhoid  stools.  A  strong  solution  should  be  jjoured 
into  the  bed-pan  before,  or  immediately  after,  an  evacuation. 


PEEPAEATIONS  OF  ANTIMONY. 

Tartar-emetic  in  the  form  of  ointment,  excites  in  the  skin  a  charac- 
teristic inflammation,  at  first  papular,  then  vascular,  and  lastly  pustular. 
The  rash  thus  runs  the  course  of  the  eruption  of  smallpox,  and  in  each 
stage  simulates  it  very  closely,  though  there  are  points  of  difference  dis- 
tiuguishable  to  a  practised  eye.  Like  smallpox  eruption,  this  rash  often 
scars ;  moreover,  the  capricious  and  j^ainful  action  of  this  ointment  ren- 
ders it  an  unsuitable  external  ap]ilication. 

Tartar-emetic  ointment  used  years  ago  to  be  employed,  though  now 
very  rarely,  as  a  counter-irritant  to  obtain  a  powerful  persistent  action; 
for  instance,  to  the  scalp  in  tubercular  meningitis. 

Chloride  of  antimony  is  a  powerful  escharotic,  but  it  produces  an  ill- 
conditioned  slow-healing  sore. 

Tartar-emetic  being  the  most  used  member  of  this  group,  our  remarks, 
except  Avhen  the  contrary  is  stated,  will  apply  to  this  preparation. 

After  small  medicinal  doses  the  stomach  experiences  a  slight  sensation  of 
soreness — a  sensation  easily  mistaken  for  hunger.  Pushed  yet  further, 
the  drug  produces  increased  secretion  of  -mucus  from  the  stomach  and 
intestines,  to  the  extent  of  inducing  numerous  moist  motions ;  and, 
diarrhoea  with  colic  may  set  in.  The  bronchial  mucous  membrane  also 
yields  an  increased  secretion,  and  probably  the  secretion  of  the  whole  mu- 
cous tract  is  augmented. 

Antimony  is  never  used  as  a  purgative  ;  in  fact,  opium  is  frequently 
given  in  combination  with  tartar-emetic,  expressly  to  prevent  purgation. 
Large  doses  excite  nausea  and  vomiting.     As  an  emetic,  tartarized  anti- 


t 


ANTIMONY.  211 

mony  produces  considerable  depression,  with  much  nausea,  in  a  greater 
degree  than  those  other  emetics;  and  the  repeated  vomiting  is  accom- 
panied by  great  straining.  Its  action  is  somewhat  tardy,  sometimes 
twenty  minutes  to  half  an  hour,  hence  in  cases  of  poisoning  it  is  an  un- 
suitable emetic. 

Majendie  has  shown  that  when  injected  into  the  veins  tartar-emetic 
excites  nausea,  even  after  the  removal  of  the  stomach  and  its  substitution 
by  a  pig's  bladder;  hence  it  has  generally  been  held  that  this  salt  pro- 
duces vomiting,  not  by  its  effects  on  the  stomach,  but  on  the  nervous 
centres.  Grimm  finds  that  when  injected  into  a  vein  it  excites  vomiting 
more  slowly,  and  a  larger  dose  is  required  than  when  administered  by 
the  stomach,  whence  he  concludes  that  it  produces  vomiting  by  its  effects 
on  the  termination  of  the  nerves  of  the  stomach.  He  disposes  of  the 
difficulty  raised  against  this  view  by  Majendie's  experiment,  by  assuming 
that  tartar-emetic  excites  nausea  by  its  effects  on  the  termination  of  the 
nerves  of  the  oesophagus  and  intestines.  Other  observers  explain  the 
foregoing  facts  by  the  supposition  that  tartar-emetic  acts  both  through 
the  terniinations  of  the  nerves  of  the  stomach  and  directly  on  the  centre 
for  vomiting. 

Tartar-emetic  was  formerly  employed  to  induce  muscular  weakness  and 
relaxation  of  spasm,  to  facilitate  the  reductions  of  dislocations  and  hernia; 
but  in  such  cases  chloroform  has  now  completely  superseded  it. 

Trousseau  taught  that  food  influences  greatly  the  action  of  antimony,  a 
low  diet  favoring  the  production  of  its  constitutional  effects,  and  a  full 
diet  its  emetic  and  purgative  effects.  Its  action  is  further  modified  by  the 
quantity  of  water  administered  Avith  it,  this  being  small,  vomiting  takes 
place,  if  large,  diarrhoea.  Trousseau  further  observed  that  certain  sub- 
stances modify  the  effects  of  antimony  ;  for  wine  and  acid  fruits,  both 
fresh  and  preserved,  develop  its  emetic  and  purgative  properties. 

The  soluble  antimony  compounds  easily  enter  the  blood,  but  the  form 
they  assume  there  is  unknown.  Possibly  the  oxide  of  the  metal,  either 
in  the  stomach,  intestines,  or  blood,  combines  with  albumen,  forming  an 
albuminate.  Antimony  compounds,  it  is  said,  do  not  combine  with  albu- 
men, except  in  acid  solutions,  when  an  insoluble  compound  is  formed. 

In  antimonial  poisoning  there  is  great  motor  and  sensory  paralysis,  and 
loss  of  reflex  action.  The  loss  of  reflex  action  and  motor  power  Radzie- 
jewski  shows  is  clue  to  the  effect  of  the  tartar-emetic  on  the  cord.  This 
salt  also  powerfully  affects  the  heart  in  the  frog,  slowing  and  then  arresting 
it  in  diastole;  and  it  affects  the  heart  of  warm-blooded  animals  in  the 
same  Avay.  The  arterial  pressure  falls  greatly.  "Whilst  the  pulse  is  slow 
the  diastolic  pauses  are  long,  but  each  beat  influences  the  mercurial  column 
of  the  cardiometer  five  times  more  than  normal.  After  a  large  dose  the 
pulse  at  last  becomes  very  frequent  and  feeble,  and  the  heart  stops  in  dias- 
tole. Tartar-emetic  directly  affects  the  heart;  affects  it  even  when  the 
heart  is  removed  from  the  body.  Radziejewski  has  shown  that  the  ends 
of  the  vagi  are  paralyzed,  and  Ackermann  that  the  contractility  of  the 
cardiac  muscle  is  destroyed. 

In  the  Journal  of  Physiology,  I  have  published,  in  conjunction  Avith 
Mr.  Murrell,  some  experiments  showing  that  tartar-emetic,  like  potash- 
salts,  arsenious  acid,  aconitia  and  hydrocyanic  acid,  is  a  protoplasmic 
poison  which  destroys  the  functions  of  all  the  organs  of  the  body  in  the 
order  of  their  vital  endowments.  We  have  shoAvn  that  the  general  paral- 
ysis which  ensues  in  a  frog  in  the  hypodermic  injection  of  tartar-emetic  is 


212  ANTIMONY. 

due  to  the  action  of  the  drug  on  tlie  spinal  cord,  thus  confirming  previous 
experimenters  :  and  tliat  tartar-emetic  is  also  a  direct  paralyzer  of  the 
motor  nerves,  and  of  the  muscles.  Our  experiments  confirm  the  conclu- 
sions of  previous  observers  concerning  the  action  of  tartar-emetic  on  the 
muscular  substance  of  the  heart. 

We  have  thus  shown  that  tartar-emetic  paralyzes  the  central  nervous 
system,  the  motor  nerves,  the  muscles,  and  destroys  sensation,  and  there- 
fore we  are  led  to  infer  that  probably  tartar-emetic  is  a  protoplasmic 
poison,  destroying  function  in  all  nitrogenous  tissue.  Our  experiments, 
however,  fail  to  show  whether  it  manifests  for  all  nitrogenous  tissues  an 
equal  affinity,  or  whether  it  has  a  special  action  on  some. 

As  in  the  case  of  potash  salts,  arsenious  acid  and  aconitia,  tartar-emetic, 
we  suggest,  weakens  or  parlyzes  the  heart  through  its  action  on  all  the  tis- 
sues, ganglia,  nerves,  and  muscular  substances  of  this  organ,  affecting  first 
the  ganglia,  then  the  nerves,  and  last  the  muscular  substances. 

Tartar-emetic  is  a  general  as  well  as  a  cardiac  depressant.  The  gen- 
eral depression  is  usually  attributed  to  the  action  of  the  drug  on  the  heart; 
but,  as  antimony  is  a  poison  to  all  nitrogenous  tissues,  I  would  suggest  that 
its  depressing  action  is  due  also  to  its  effects  on  the  central  nervous  sys- 
tem, the  nerves,  and  the  muscles. 

We  noticed  a  peculiar  effect  of  tartar-emetic  on  the  skin.  In  a  few 
hours  the  cuticle  of  a  poisoned  frog  became  softened  and  gelatiniform,  too 
soft  to  be  stripped  off,  though  it  could  be  easily  scraped  off  every  part  of 
the  bod}'.  Even  small  noses  soon  produce  this  remarkable  effect,  for  in 
one  experiment  the  skin,  after  a  small  dose,  became  in  this  condition  even 
whilst  the  animal  could  still  crawl  pretty  well. 

Miss  Nunn,  under  the  direction  of  Dr.  Michael  Foster,  has  carefully 
worked  out  the  effect  of  tartar-emetic  on  the  skin,  and  the  results  are 
published  in  the  Journal  of  Phifsiology,  1878;  and  to  her  investigation  I 
shall  refer  in  the  article  on  arsenic.  Malcolm  Morris  highly  praises  tar- 
tar-emetic in  32-grain  doses  in  acute  eczema.  It  is  less  successful  in  the 
chronic  forms. 

Like  arsenic  and  phosphorus,  tartar-emetic  destroys  the  glycogenic 
function  of  the  liver,  and  induces  fatty  degeneration  of  this  and  other 
organs.  It  splits  up  the  nitrogenous  matter  into  fat  and  some  compound 
wherefrom  leucin.  tyrosin,  and  urea  are  formed,  so  that  in  case  of  anti- 
mony poisoning  there  is  incre^tsed  formation  of  urea  in  the  urine,  and 
increased  elimination  of  carbonic  acid  in  the  expired  air;  moreover,  tar- 
tar-emetic increases  both  the  insensible  perspiration  and  the  vapor  from 
the  lungs,  but  chiefly  the  secretion  from  the  skin.  Tartar-emetic  wine 
is  commonly  given  as  a  diaphoretic  in  fevers. 

Many  cases  of  ague  may  be  cured  by  tlie  impression  emetics  make  on 
the  system.  An  emetic  administered  each  morning  will  help  the  action 
of  quinine,  for  cases  rebellious  to  quinine  alone  often  yield  immediately 
to  the  joint  action  of  quinine  and  emetics.  Ipecacuanha  and  other 
emetics  should  be  preferred  to  antimony. 

Antimony  will  not  lower  the  temperature  of  the  body  of  a  healthy 
person,  if  one  experiment  may  be  accepted  as  sufficient  to  settle  this 
point.  To  a  strong  young  man  I  gave  tartar-emetic  in  half-grain  doses 
every  ten  minutes  for  nearly  seven  hours,  inducing  great  nausea  and 
vomiting,  with  profuse  perspiration;  but  during  the  whole  time  his 
temperature  remaiiied  remiirkably  constant,  varying  not  more  than  0.4° 
Fahr.  an  amount  of  deviation  quite  within  the  limits  of  health. 


f! 


ANTIMONY.  213 

Tartar-emetic  acts  in  many  respects  like  aconite;  given  in  3V  ^o  g-^ 
grain  doses  each  hour  to  a  fever  patient  it  produces  copious  perspiration 
and  slows  the  pulse,  and  with  the  perspiration,  restlessness,  etc.,  disappear. 
In  3V)  gi*ain  doses  it  often  excites  troublesome  sickness,  even  in  adults,  and 
it  is  better  therefore  to  begin  with  a  -^\  to  g-^  grain.  In  my  experience 
aconite,  tartai'-emetic,  and  carbonate  of  ammonia  are  the  most  powerful 
diaphoretics  in  fever,  and  next,  though  a  long  way  inferior,  acetate  of 
ammonia. 

Tartar-emetic  is  highly  useful  in  catarrh  of  any  part  of  the  respi- 
ratory tract.  A  dose  of  -gV  of  a  grain  hourly  induces  perspiration  and 
secretion  from  the  mucous  membrane,  and  cuts  short  the  attack.  Small 
hourly  doses  are  preferable  to  larger  doses  at  longer  intervals,  for  larger 
doses  may  excite  nausea  and  even  vomiting  with  much  depression.  Be- 
ing tasteless,  this  is  an  excellent  treatment  for  children,  for  the  drug 
may  be  made  quite  palatable  by  the  addition  of  syrup  of  orange  peel. 
The  addition  of  a  small  dose  of  potassium  iodide,  as  one-sixth  of  a  grain 
in  each  dose,  heightens  its  action. 

Antimony  administered  in  the  same  way  will  shorten  and  moderate 
attacks  of  feverish  cold,  tonsillitis,  pleurisy,  orchitis,  bronchitis,  puer- 
peral peritonitis,  inflammation  of  the  breast,  whitlow  and  other  inflam- 
matory affections. 

Antimony  is  serviceable  in  chronic  bronchitis,  when  the  expectora- 
tion is  copious,  frothy,  and  difficult  to  expel. 

In  the  following  disease  tartar-emetic  is  invaluable : — 

A  child  six  to  twelve  years  old  on  the  slightest  exposure  to  cold  is 
attacked  with  much  wheezing  and  some  difficulty  of  breathing,  some- 
times so  urgent  as  to  compel  him  to  sit  all  night  propped  with  pillows. 
The  expectoration  may  be  pretty  abundant,  but  a  child  of  this  age  does 
not  generally  expectorate.  On  listening  to  the  chest  there  is  heard  much 
sonorous  and  sibilant,  with  perhaps  a  little  bubbling,  rhoncus;  but  this 
last  is  often  absent.  The  wheezing  is  audible  for  a  considerable  distance, 
and  sometimes  the  noise  is  so  great  as  to  be  heard  many  rooms  off.  Oc- 
casionally the  cough  is  troublesome,  and  on  each  exposure  to  cold  the 
voice  may  become  hoarse,  and  the  cough  hollow  and  barking.  Some 
children  become  thus  afflicted  whenever  the  weather  is  cold,  even  in 
summer  and  may  not  be  free  the  whole  winter :  with  others  the  attack 
lasts  only  a  few  weeks  or  days.  This  affection  sometimes  follows 
measles.  It  is  compared  by  the  mother  to  asthma,  with  which,  if  not 
identical,  it  is  certainly  allied. 

The  best  way  to  administer  this  salt  is  to  dissolve  a  grain  of  it  in 
half  a  pint  of  water  and  to  give  a  teaspoonful  of  the  solution  every 
quarter  of  an  hour  for  the  first  hour,  afterwards  hourly.  If  the  wheez- 
ing comes  on  at  night  it  is  sufficient  to  give  the  medicine  at  this  time 
only. 

The  good  effects  of  the  medicine  become  speedily  evident;  for 
on  the  very  first  night  it  often  greatly  benefits  the  child.  So  small  a 
dose,  it  may  be  thought,  must  be  inefficacious,  but  when  first  given  it 
generally  produces  vomiting  once  or  twice  in  the  day,  and  as  it  is  not 
necessary  to  produce  sickness,  the  dose  in  this  case  must  be  still 
smaller. 

There  is,  however,  an  affection  unaffected  by  tartar-emetic  somewhat 
similar  to  that  Just  described,  which  it  is  necessary  to  discriminate  from 
it.     It  occurs   in    children  a  few  months  old,  and  consists  of   a  loud 


f 


214  ANTIMONY. 

rattling,  wliich  is  obviously  caused  by  niuous  in  the  throat  or  larynx. 
In  some  cases  the  rattling  is  worse  in  the  day,  but  is  usually  worse  at 
night. 

There  is  no  bronchitis,  or  if  there  is,  this  is  a  mere  coincidence;  n;iy, 
sometimes  on  the  occurrence  of  bronchitis  the  complaint  in  question 
ceases  for  a  time.  It  is  brought  on  and  aggravated  by  cold,  and  may 
last,  with  some  fluctuations,  many  months. 

Antimony  in  small  hourly  doses  is  very  useful  in  the  acute  catarrh  of 
children,  sometimes  accompanied  by  vomiting  and  diarrhcea,  probably  due 
to  catarrh  of  the  intestines.  The  intestinal  canal  is  sometimes  the  first 
attacked,  but  most  frequently  the  lungs  are  first  implicated.  The  tartar- 
emetic  generally  quickly  stays  the  vomiting  and  diarrhoea,  but  often 
takes  a  longer  time  to  control  the  bronchitis. 

Antimony  in  large  doses  was  formerly  freely  used  in  acute  pneu- 
monia. In  some  cases  small  hourly  doses  certainly  seem  very  useful 
when  administered  at  the  onset  of  the  disease. 

Graves  employed  antimony  in  typhus  and  other  fevers  when  there 
is  much  excitement  and  furious  delirium,  symptoms  which  are  generally 
subdued  by  the  exhibition  of  this  drug.  As  wakefulness  is  a  concomi- 
tant symptom,  being,  indeed,  the  cause  of  the  excitement  and  delirium, 
opium  should  be  added  to  the  antimony.  The  combined  influence  of 
these  remedies  calms  the  excitement,  and  induces  refreshing  sleep,  out 
of  which  the  patient  wakes  refreshed  and  free  from  delusions.  Judi- 
ciously employed,  these  remedies  may  save  an  almost  hopeless  life. 
Each  drug  appears  to  assist  the  action  of  the  other,  and  the  relative  doses 
must  be  determined  by  the  circumstances  of  the  case.  In  furious  de- 
lirium the  tartar-emetic  must  be  given  in  full,  and  the  opium  in  small, 
quantities;  while,  if  wakefulness  predominates,  with  not  very  boisterous 
delirium,  the  dose  of  tartar-emetic  must  be  reduced,  and  the  opium  in- 
creased. 

Graves  advises  one-fourth  to  one-half  a  grain  of  the  salt  every  hour 
or  two  hours,  to  be  discontinued  when  it  produces  bilious  stools.  This 
treatment  is  very  useful  in  the  delirium  which  usually  sets  in  about  the 
ninth  or  tenth  day  of  t3q3hus. 

The  mania  and  sleeplessness  of  delirium  tremens  generally  give  way 
to  the  same  treatment. 

Puerperal  mania  may  be  treated  in  the  same  way,  although  probably 
bromide  of  potassium  and  cliloral  give  better  results. 

Tartar-emetic  given  to  the  extent  of  producing  nausea  and  vomiting 
once  or  twice  a  day  is  sometimes  useful  in  chorea.  (See  Sulpliate  of 
Zinc)  Increasing  doses  must  be  given,  as  the  system  aj^pears  soon  to 
tolerate  it.     Other  remedies,  however,  are  more  efficient. 

In  strumous  ophthalmia  tartar-emetic  may  be  given  with  advan- 
tage, in  doses  of  l-3Gth  to  l-48th  of  a  grain  three  or  four  times  a  day. 
Sharp  purgation  at  the  commencement  of  the  treatment  is  highly 
useful. 

In  acute  poisoning  by  tartar-emetic  violent  and  continuous  vomiting 
occurs,  accompanied  with  a  diarrhoea  of  bilious  and  bloody  stools,  and 
sometimes  the  common  symptoms  of  gastro-enteritis,  and  sometimes  of 
peritonitis,  are  present.  The  prostration  is  intense  and  jn-ofound.  and 
repeated  faintings  take  place.  The  respirations  and  the  pulse  are  said 
to  be  reduced  both  in  frequency  and  in  strength;  otheis  assert  that  the 
pulse  is  more  frequent. 


ARSENIC.  215 

The  post-mortem  appearances  are  inflammation  of  the  stomach  and 
intestines,  but  not  often  of  the  gullet.  The  peritoneum  may  be,  and, 
according  to  Harley,  the  rectum  often  is,  inflamed,  and  some  inflamma- 
tion of  the  lungs  is  usually  observable,  tending  to  make  it  probable  that 
tartar-emetic  exerts  an  especial  action  on  these  organs. 

In  the  treatment  of  poisoning  by  tartar-emetic  the  vomiting  should 
be  promoted  by  warm  demulcent  drinks,  while  strong  tea  or  colfee,  tan- 
nin, or  decoction  of  oak  bark  should  be  diligently  administered. 

The  statements  concerning  the  influence  of  antimony  on  the  urine 
are  conflicting. 

The  probable  effect  of  tartar-emetic  on  this  excretion  is  to  lessen 
the  amount  of  water  and  of  chloride  of  sodium,  owing  to  increased  per- 
spiration. 

The  urea  is  greatly  increased,  apparently  in  proportion  to  the  dose 
of  the  antimony;  so  is  the  pigment  and  uric  acid,  but  in  a  less 
degree. 

Antimony  is  separated  chiefly  by  the  kidneys;  some,  however,  passes 
with  the  bile,  and  by  the  stomach  and  intestines.  A  portion  is  retained 
in  the  body. 


PREPAEATIONS  OF  ARSENIC. 

Aesenious  acid  is  poisonous  to  many  of  the  lower  forms  of  animal  life, 
but  it  does  not  impair  the  action  of  animal  ferments,  as  pepsin,  pancrea- 
tine, etc. 

Dry  arsenious  acid  produces  no  changes  in  the  unbroken  skin,  but  in 
wounds  or  sores  it  excites  very  active  ijiflammation,  with  much  pain,  suffi- 
cient, if  the  application  is  a  strong  one,  to  destroy  the  tissues  for  some 
depth.  Arsenious  acid  has  long  been  used  to  destroy  warts,  condylomata, 
cancerous  growths,  the  nerve  of  a  carious  tooth,  etc. 

It  may  be  applied  pure,  or  mixed  in  variable  quantities  with  some  bland 
powder,  as  starch.  At  times  this  application  has  enjoyed  a  high  reputa- 
tion, whilst  at  other  times  it  has  fallen  into  almost  complete  disuse. 
Some  have  fallen  victims  to  this  treatment,  it  is  said,  through  the  absorp- 
tion of  arsenic  in  sufficient  quantity  to  destroy  life;  but  an  untoward  re- 
sult like  this  can  occur  only  when  certain  well-known  precautions  are  dis- 
regarded. Absorption  can  be  effectually  prevented  if  sufficient  arsenic  is 
employed  to  excite  active  inflammation;  for  inflamed  tissue  loses  the 
power  of  absorption  more  or  less  completely.  Produce  active  inflamma- 
tion, and  the  patient  is  safe;  but  if,  through  fear  of  poisoning,  too  little 
arsenic  is  used,  that  is  the  most  efficacious  way  of  doing  what  it  is  desired 
to  avoid.  Surgeons  experienced  in  the  employment  of  arsenic  recommend 
that,  if  the  tissues  to  be  destroyed  are  extensive,  the  arsenic  shovild  be 
applied  to  a  part  only  of  the  surface  at  a  time.  When  employed  to  re- 
move large  growths,  like  cancer,  the  skin  being  unbroken,  incisions  are 
first  made,  and  into  these  the  arsenical  paste  is  laid,  which  soon  stirs  up 
active  and  deep-seated  inflammation,  and  the  growth  dies  for  a  considerable 


21(5  ARSENIC. 

depth.  The  whole  tumor  often  sloughs  away  from  the  healthy  tissues — 
is  in  fact  enucleated — leaving  a  clean  and  healthy  sore,  which  heals  with- 
out trouble  in  fifteen  to  thirty  days. 

Lupus  and  other  obstinate  skin  affections  may  be  treated  in  the  same 
way. 

Arsenious  acid  and  powdered  acacia,  of  each  an  ounce,  blended  with 
five  fluid  drachms  of  water,  form  an  arsenical  mucilage  much  used  by 
Doctor  Marsden  to  remove  epitheliomatous  growths.  Some  of  this  arseni- 
cal mucilage  is  to  be  painted  over  the  tumor  night  and  morning,  great 
care  being  taken  to  limit  its  employment  to  the  diseased  tissues.  Each 
application,  covering  not  more  than  a  square  inch,  is  to  be  several  times 
repeated,  and  the  separation  of  the  sloughs  aided  by  poulticing. 

The  following  powder  may  also  be  used: — Fresh  lime,  half  an  ounce; 
yellow  sulphide  of  arsenic,  20  grains;  starch,  180  grains.  The  arsenic 
should  constitute  one-fifth  or  one-sixth  part  of  the  arsenical  powder,  so  as 
to  insure  the  excitation  of  sufficient  inflammation  to  prevent  poisonous  ab- 
sorption.    This  powder  may  be  also  cautiously  used  as  a  depilatory. 

Liquor  arsenicalis  painted  over  warts  is  said  to  cause  them  to  disappear, 
and  a  limited  experience  leads  me  to  believe  that  the  arsenic  does  appear 
to  disintegrate  the  wart,  so  that  pieces  of  it  drop  off,  or  can  be  picked  out. 
If  very  large  it  must  first  be  dissolved  away  with  liquor  potassae,  to  allow 
the  liquor  arsenicalis  to  come  in  contact  with  the  softer  tissues  below.  It 
has  appeared  to  me  to  be  also  a  useful  application  to  corns.  The  corn 
should  be  well  pared  down  and  the  liquor  arsenicalis  applied  thrice  daily. 
This  treatment  I  have  seen  greatly  improve  even  hard  corns  on  the  sole 
of  the  foot.    Salicylic  acid  is  a  very  useful  apjDlication  to  corns. 

An  arsenical  bath  is  useful  in  some  forms  of  rheumatoid  arthritis.  It 
is  made  by  adding  to  the  water  in  an  ordinary  general  bath  four  ounces 
of  common  washing  soda  and  twenty  grains  of  arseniate  of  soda. 

Arsenic  has  a  sweetish  taste.  In  moderate  doses  it  apparently  neither 
undergoes  nor  produces  any  changes  in  the  mouth.  Dentists  employ  it 
as  an  escharotic  to  destroy  the  exposed  sensitive  pulp  of  decayed  teeth,  or 
to  destroy  the  pulp  before  stopping  the  tooth.  If  used  to  quell  pain,  the 
arsenic  may  be  mixed  with  opium;  it  sometimes  fii'st  aggravates  the  pain. 

We  see,  chiefly  in  children  and  occasionally  in  adults,  a  circular  rash 
on  the  tongue,  which  begins  at  a  point,  then  enlarges,  and  separate  rings 
may  coalesce.  Sometimes  the  edges  are  not  raised,  and  the  patch  looks  as 
if  due  merely  to  separation  of  epithelium,  leaving  the  surface  unduly  clean 
and  smooth ;  in  other  cases  the  edges  are  raised,  and  have  a  gelatinous  aspect. 
This  affection  is  often  very  obstinate,  frequently  recurring,  and  is  generally 
connected  with  stomach  or  intestinal  disturbance;  some  cases  being  always 
associated  with  diarrhaa.  Other  cases  are  associated  with  a  rash  over  the 
body,  like  lichen  urticatus.  In  this  affection  of  the  tongue  arsenic  has 
appeared  to  me  to  be  useful. 

The  vapor  of  arsenical  cigarettes  drawn  into  the  lungs  is  sometimes 
useful  to  prevent  or  to  lessen  attacks  of  asthma,  and  in  acute  and  chronic 
coryza  and  chronic  i)roncliitis.  They  may  be  made  by  saturating  paj^er 
with  a  solution  containing  fifteen  grains  of  arsenite  of  potash  in  an  ounce 
of  water.     (Stille. ) 

These  cigarettes  may  be  used  in  chronic  phthisis. 

Arsenic  given  in  medicinal  doses  is  very  effective  in  sloughing  of  the 
mouth  or  throat,  malignant  sores,  as  cancrum  oris,  malignant  sore 
throat  and  the  like.     It  is  also  useful  in  chronic  coryza. 


ARSENIC.  217 

There  are  certain  curious  complaints  of  the  respiratory  tract  more 
or  less  allied  to  asthma,  which  I  will  now  refer  to.  In  these  cases  of 
qnasi-asthma  a  close  of  one,  two,  or  three  drojis  of  the  solution  of  arsenic 
three  times  a  day  often  proves  serviceable. 

I.  A  patient  is  seized,  perhaps  daily,  or  even  several  times  a  day, 
generally  in  the  morning  directly  on  rising,  or  soon  after,  with  an  attack 
of  persistent  sneezing,  with  profuse  running  from  the  eyes  and  nose, 
accomjianied  sometimes  with  severe  frontal  headache.  Each  attack  may 
last  several  hours.  Several  days  sometimes  elapse  before  the  recurrence 
of  an  attack,  which  is  then  usually  severe,  lasting  twenty-four  hours,  or 
even  longer.  The  sneezing  is  generally  accompanied,  and  sometimes  pre- 
ceded, by  itching  at  a  small  spot  situated  inside  one  or  both  nostrils,  not 
far  from  the  orifice,  but  in  some  cases  the  itching  affects  the  whole  of 
the  inside  and  outside  of  the  nose,  extending  even  to  the  face,  sometimes 
even  to  the  lips  and  external  meatus.  The  throat  and  soft  palate  may 
itch  or  feel  rough.  These  attacks  are  excited  by  exposure  to  cold,  by 
dust,  strong  sunlight,  and  sometimes  from  unascertainable  causes. 

II.  We  occasionally  meet  with  cases,  apparently  identical  with  that  just 
described,  but  with  this  difference— the  attack  is  excited  by  food,  is  most 
severe  after  the  larger  meal,  and  lasts  from  twenty  to  forty  minutes.  One 
]iatient  felt  itching  in  the  nose,  throat  and  ears,  in  distinctly  periodic 
monthly  attacks,  worse  in  summer.  This  attack  was  brought  on  by  food, 
but  a  chill  sometimes  brought  on  a  paroxysm. 

III.  Arsenic  is  invaluable,  too,  in  another  more  developed  and  severer 
form.  We  not  seldom  find  a  patient,  prone  to  catch  cold,  attacked  Avith 
severe  and  repeated  fits  of  sneezing,  accompanied  with  profuse  clear  nasal 
discharge,  and  severe  frontal  headache.  Each  attack,  generally  worse  in 
the  morning,  lasts  a  few  days;  but,  owing  to  the  great  susceptibility  to 
cold,  it  frequently  recurs.  Severe  itching  of  the  ala  of  one  or  both  nos- 
trils often  forewarns  the  patient  of  an  approaching  attack.  A  simple  ir- 
ritant like  dust  may  be  adequate  to  excite  paroxysm.  Continuing  in  this 
form  for  some  time,  occasionally  for  years,  the  affection  may  then  extend 
from  the  nose,  along  the  throat,  to  the  lungs,  j)roducing  sore  throat,  soon 
followed  by  much  difficulty  of  breathing,  great  wheezing,  and  free  expec- 
toration. The  lung  affection  may  last  for  some  weeks.  When  this  severe 
form  has  become  established  the  lungs  may  be  attacked  without  any  pre- 
liminary affection  of  the  nose  or  throat. 

IV.  Again,  among  children,  we  not  uncommonly  meet  with  a  similar, 
and  perhaps  identical,  disease.  A  child,  perhaps  six  months  old,  under- 
goes a  severe  attack  of  bronchitis,  and  thenceforth  becomes  very  prone  to 
catch  cold.  Then,  on  catching  cold,  he  is  seized  with  frequent  and  inces- 
sant sneezing,  lasting  a  variable  time,  sometimes  a  few  hours,  sometimes 
three  or  four  days,  and  resulting  in  bronchitis,  accompanied  by  much 
fever,  wheezing,  and  great  embarrassment  of  breathing,  severe  enough 
even  to  compel  the  patient  to  sit  up  in  bed.  The  coryza  may  sometimes 
precede  the  dyspnoea  three  or  four  days,  the  shortness  of  breath  continu- 
ing for  many  days,  or  even  weeks  after  the  cessation  of  the  coryza.  It  is, 
indeed,  a  form  of  asthma.  The  child  encounters  many  attacks  in  the  year, 
especially  during  the  winter,  and  may  continue  liable  to  them  for  years, 
and  then,  perhaps,  lose  them,  or  they  may  engender  life-long  asthma. 

V.  Or  we  meet  with  cases  like  the  following: — A  patient  suffers  from 
asthma  for  several  years,  and  then  is  seized  with  severe  attacks  of  sneez- 
ing. These  attacks,  strange  to  say,  may  not  occur  coincidently  with 
the  paroxysm  of  dyspnoea,  the  sneezing  takes  place  in  the  morning  on 


218  ARSENIC. 

rising,  whilst  the  difficulty  in  breathing  comes  on  in  the  afternoon,  or  at 
night. 

These  cases  appear  related  on  the  one  hand  to  broiichitic  and  dyspeptic 
asthma,  and  on  the  other  hand  to  hay  fever.  They  are  allied  to  the  bron- 
chitic  form  of  asthma,  being  excited  by  dust,  cold,  and  direct  irritants; 
and  to  bronchitic  asthma,  through  those  cases  where  the  paroxysmal  coryza 
is  always  accompanied  by  a  bronchial  asthma;  and  again,  to  bronchitic 
asthma,  through  those  cases  commencing  as  paroxysmal  coryza,  the  disease 
extending  and  becoming  complicated  with  bronchial  asthma,  or  vice  verm. 
To  the  peptic  forms  of  asthma  this  paroxysmal  sneezing  is  related  through 
those  cases  where  the  attack  is  excited  by  food;  and  those  where  the 
patient,  a  confirmed  asthmatic  for  many  years,  then  becomes  afflicted  with 
paroxysmal  coryza,  induced  by  food,  the  asthma  at  last  ceasing,  the  coryza 
alone  remaining.  This  typical  case  further  illustrates  the  connection 
between  ])aroxysmal  sneezing  and  dyspeptic  asthma;  a  child  since  six 
months  old  is  subject  to  attacks  occurring  every  few  months,  most  com- 
mon in  winter,  beginning  with  not  very  severe  sneezing,  lasting  from  a 
day  to  a  week,  often,  but  not  invariably,  followed  by  an  attack  of  bron- 
chitis, with  much  difficulty  of  breathing,  and  fever.  Even  when  free 
from  an  attack  the  child,  after  a  full  meal,  suffers  from  stuffy  breathing. 

The  following  cases,  occurring  in  the  course  of  four  generations  in  the  same  family, 
show  the  intimate  connection  between  the  intermittent  sneezing  and  astlima,  for  astlima 
was  followed  in  the  grandson  by  hay-asthma,  and  he  begot  an  asthmatic  child,  Avho 
suffers  all  the  year  round  from  severe  attacks  of  itching  and  sneezing,  not  due  to  pollen, 
as  was  the  case  with  his  father;  one  patient  showing  that  even  hay-asthma  may  be 
intiuenced  by  climate,  whilst  his  son  especially  exemi^litied  the  intimate  connection 
between  intermittent  sneezing  and  asthma,  for  in  his  case  both  co-existed,  and  both 
were  peptic  in  kind,  being  each  greatly  and  mainly  intiuenced  by  diet,  and  in  the  case 
of  his  father  also  by  climate. 

Mr.  H. ,  aged  35.  His  grandfather  was  asthmatic  for  years,  dying  clgse  upon  eiglity 
years  of  age.  Mr.  H.  himself  suffered  from  hay-asthma  from  babyhood.  The  attacks 
occur  only  in  the  .spring  during  the  hay  season,  and  last  six  weeks.  If  he  goes  into  a 
hay -field,  nay,  near  one,  he  is  stricken  immediately  with  a  .severe  attack  of  intense 
itching  of  tlae  whole  inside  of  the  nose,  and  of  the  entire  conjimctiva  of  both  eye.% 
(though  not  over  the  frontal  sinus),  and  of  the  throat,  accompanied  b}'  violent  sneez 
ing,  and  profuse  discharge  from  the  eyes  and  nose.  His  eyes  become  bloodshot,  and 
the  lids  swell  sometimes  to  such  an  extent  that  he  can  scarcely  see.  His  breathing  is 
very  dilhcult,  and  without  expectoration.  So  intensely  su.sceptible  is  he,  that  a  field 
a  great  distance  off  will  affect  him;  nay,  if  his  children  play  in  a  hay-field,  and  then 
come  indoors  he  will  have  an  attack.  Other  flowers  besides  grass  or  roses,  etc.,  at  this 
time  will  bring  on  a  mild  attack,  but  at  no  other  time  of  the  year.  Strong  sunlight 
also  induces  them  unless  protected  by  large  dark-glassed  spectacles.  Strange  to  say  that 
whild  severely  affeetedin  Sussex-,  Ms  native  county,  he  is  quite  free  in  Windermere,  in  Scot- 
land, and  in  Devonshire,  even  tliough  the  grass  is  in  full  bloom.  Thus,  on  one  occasion  when 
suffering  from  a  .severe  attack,  he  started  for  Linton,  in  North  Devon,  and  after  leav- 
ing Barnstaple,  he  began  to  improve  more  and  more,  and  while  at  Linton  he  was  quite 
free,  though  tlie  hoiise  he  lived  in  was  close  to  a  grass  field  in  full  lilossom.  On  one 
occasion,  whilst  yachting  in  St.  George's  Ciiannel,  but  not  till  the  fourth  day  from 
land,  he  was  seized  with  a  severe  attack.  For  the  last  four  years  he  has  inhaled  cpii- 
niue  spray  through  his  nose  with  marked  l)enefit.  His  sister,  twenty-four  years  old, 
has  had  hay-asthma  for  the  last  four  years.  His  son,  aged  ten,  has  suffered  from 
severe  asthma  since  a  sharp  attack  of  bronchitis  when  three  years  old.  He  suffers  all 
the  year  round  almo.st  continuously  from  severe  itching  inside  the  nose,  in  the  eyes, 
throat,  ears,  and  under  the  chin.  When  these  .symptoms  are  aggravated,  he  has  severe 
sneezing,  with  rather  free  discharge  of  clear  tluid  from  his  nose.  Any  kind  of  dust 
aggravates  the  symptoms,  but  not  especially  pollen.  He  suffers  also  from  wheezing, 
and  when  the  itching  and  sneezing  are  aggravated,  from  much  difficulty  of  breathing 
and  violent  cough. 

All  these  symptoms  are  very  greatly  influenced  hy  food,  thus,  the  itching,  etc.,  and 
the  dyspnoea,  are  always  aggravated  by  pastry,  sweets,  and  especially  by  a  heavy  meal 


ARSENIC.  219 

taken  in  the  evening  or  late  at  night.  He  has  been  much  worse  since  an  attack  of  the 
measles  tliree  months  ago,  and  subsequently  any  food,  even  bread  and  butter,  increases 
botli  the  itching  and  tlie  ditficulty  of  breathing.  He  does  not  easily  catch  cold  at  Brigh- 
ton, where  he  is  always  free  from  all  his  troubles,  and  on  one  visit  to  Linton  he  lost  all 
his  symptoms  during  his  .sojourn  there.  His  stomach  has  lately  been  very  delicate,  so 
that  he  vomits  very  readily.  He  is  very  flat-chested  and  round-shouldered,  he  wheezes 
loudly,  and  his  expiration  is  very  greatly  prolonged. 

The  following  interesting  and  instructive  family  history  throws  much 
light  on  the  affinities  of  these  ciirions  complaints.  A  woman  when  young 
suffered  from  bronchial  asthma,  which  left  her  for  some  years,  and  then 
she  became  affected  with  hay-asthma.  She  bore  two  sons.  One,  aged 
nineteen,  has  suffered  for  two  years  every  morning  during  the  summer 
from  violent  attacks  of  sneezing,  and  profuse  watery  discharge.  These 
attacks  are  not  excited  by  hay  nor  the  smell  of  flowers. 

Another  son,  aged  thirty,  has  been  subject  to  asthma  and  bronchitis 
since  five  years  of  age.  It  began,  and  for  a  long  time  continued,  of  the 
same  character  as  that  so  often  seen  in  the  commencement  of  asthma,  es- 
pecially in  young  children,  beginning  by  an  attack  of  cold  in  the  head, 
with  fever,  lasting  ai)out  three  days,  followed  by  about  nine  days  of 
asthma.     (See  Aconite.) 

The  bronchial  asthma  of  the  mother  was  most  severe  in  the  winter.  From  this  she 
quite  recovered,  and  remained  well  for  several  years;  but  during  the  last  ten  years 
she  has  suffered  from  well-marked  hay-asthma,  the  attacks  being  apparently  solely  due 
to  hay. 

Her  son,  aged  19,  for  two  years  has  sutfered  from  violent  attacks  of  sneezing  and 
much  running  from  the  nose,  the  paroxysms  lasting  sometimes  for  hours.  They  are 
accompanied  by  much  itching  of  the  whole  inside  of  the  nose.  There  is  no  dyspncea 
or  wheezing.  These  attacks  occur  chiefly  in  the  morning,  directly  he  gets  up,  but  they 
may  seize  him  at  any  hour  of  the  day.  He  can  go  into  a  hay-field,  or  smell  flowers, 
without  producing  the  slightest  trace  of  an  attack.  They  are  brought  on  by  dust  and 
strong  sunlight;  these  being  the  only  causes  he  has  detected,  but  he  cannot  account 
for  those  attacks  beginning  directly  he  gets  out  of  bed.  The  complaint  lasts  the  whole 
summer,  leaving  him  in  the  winter.     The  attacks  are  not  affected  by  food. 

His  brother,  aged  80,  has  suffered  from  bronchitis  and  asthma  since  five  years  old. 
At  first  the  attacks  began  with  cold  in  the  head  and  fever,  without  much  sneezing. 
This  stage  lasted  about  three  days,  when  his  throat  became  slightly  sore,  and  next 
bronchitis  set,  in.  To  use  his  own  words,  he  has  generally  three  days'  cold  in  the 
head,  and  nine  days  asthma,  tlnnigh  sometimes  the  asthma  lasted  much  longer, 
indeed,  sometimes  continuing  for  mouths.  As  he  has  grown  older,  the  attacks  have 
undergone  considerable  modification.  The  chest  symptoms  begin  with  a  cold  in  the 
head,  or  may  occur  without  it.  He  is  obliged  to  take  the  greatest  care,  for  the  chill 
brings  on  an  attack.  Strange  to  say,  conditions  which  at  one  time  induce  an  attack  are 
inoperative  at  another.  Thus,  he  can  sometimes  join  a  hay  party  without  being 
affected,  yet  at  otlier  times,  going  into  a  stable,  or  passing  a  hay-cart,  not  to  mention 
going  into  a  hay-field,  brings  on  a  violent  attack.  Dust,  as  house  dust,  builders'  dust, 
excites  an  attack;  so  does  strong  sunlight  or  flowers.  An  attack  induced  by  any  of 
these  agents,  consists  in  itching  of  the  nose,  violent  sneezing,  with  jirofiise  discharge 
from  eyes  and  nose,  the  itching  and  discharge  being  usually  most  marked  in  the  left 
nostril,  though  sometimes  the  right  nostril  is  implicated.  In  addition,  he  suffers  from 
dyspnoea.  The  coryzal  symptoms  always  occur  in  the  day,  the  dyspnani  at  night. 
When  troubled  with  asthma,  the  dyspna?a  is  considerably  aggravated  by  food,  which, 
however,  at  any  other  time  does  not  produce  any  tightness  of  tiie  breath. 

Strong  black  coffee,  even  the  smell  of  it,  immediately  relieves  the  dyspnoea,  but  is 
without  effect  on  his  coryza. 

The  fumes  from  Ilimrod's  powder  wonderfully  relieve  both  the  coryza  and  dysp- 
noea. All  inhalations,  with  the  foregoing  exception,  "tighten  him  up  everywhere, 
even  in  his  nose  and  throat. ' ' 

In  some  cases  the  irritability  appears  to  be  limited  to  the  nasal  mucous 
membrane,  or  even  to  a  very  limited  portion  of  it.     In  other  cases,  after 


220  ARSENIC. 

continuing  in  this  form  for  some  time,  tlie  mucous  membrane  of  the  tliroat 
may  become  involved,  and  subsequently  the  bronchial  mucous  mem- 
brane; or  vice  versa,  beginning  at  the  bronchial  mucous  membrane,  the 
irritability  may  involve  the  nose.  In  either  case  the  disease  may  quit 
the  portion  of  mucous  membrane  originally  affected,  an  incident"  most 
common  when  the  attack  first  affects  the  territory  of  the  fifth  nerve. 
Indeed,  in  my  experience,  this  is  not  an  unusual  way  for  asthma  to  be- 
gin in  children;  and  as  they  grow  u]),  the  coryzal  symptoms  cease,  and 
ordinary  bronchitic  asthma  alone  remains. 

On  the  other  hand,  these  cases  of  paroxysmal  coryza  are  related  to  hay- 
asthma,  which,  indeed,  appears  to  be  the  same  disease,  but,  owing  to  the 
patient's  idiosyncrasy,  the  attack  is  induced  only  by  the  pollen  of  plants; 
the  similarity  between  these  affections  being  shown  by  the  fact  that  in 
each  the  mischief  may  be  limited,  to  the  nose,  frontal  sinuses,  and.  eyes, 
or  extending  further,  may  involve  the  lungs. 

Mr.  Blackley,  in  an  admirable  paper,  sliows  that  in  his  own  case,  and 
in  some  other  instances,  hay  asthma  is  solely  due  to  the  irritant  effects  of 
the  pollen  of  plants.  He  conducted  an  extensive  series  of  experiments 
with  the  pollen  of  many  grasses,  cereals,  etc.,  and  found  that  all  are  capa- 
ble of  exciting  an  attack,  although  some  kinds  of  pollen  are  more  active 
than  others.  The  pollen  of  poisonous  plants  is  not  more  virulent  than 
that  of  harmless  plants;  indeed,  he  finds  that  pollen  of  solanaceous  plants 
will  excite  a  slight  fit,  while  the  pollen  of  wheat  excites  a  very  severe 
attack.  In  his  own  person,  and  some  other  cases,  he  clearly  shows  that 
all  the  agents  hitherto  supposed  to  be  severally  productive  of  asthma,  as 
ozone,  heat,  strong  sunlight,  the  volatile  principle  on  which  the  odor  of 
plants  depends,  oleo-resins,  dust,  unless  it  contains  pollen,  are  powerless 
to  produce  a  paroxysm.  In  other  cases  it  appears  that  one  or  more  kinds 
of  pollen  only  will  produce  the  attack.  Thus,  rose-pollen  excites  the  at- 
tack only  in  some  patients;  and  it  is  said  that  in  America  Koman  worm- 
wood is  a  freqiient  cause.  Hay- asthma  and  the  diseases  just  described  are 
indeed  identical,  but,  owing  to  individual  idiosyncrasy,  the  attack  is  in- 
duced in  one  person  b}^  one  irritant,  and  in  another  by  a  different  irritant. 
In  some  cases  the  attack,  as  we  have  seen,  is  induced  by  pollen,  in  other 
cases  by  ipecacuanha,  or  by  animal  emanations,  as  from  rabbits,  cats, 
horses,  the  smell  of  mustard,  feathers,  or  a  /privet  hedge,  etc.  Dr.  W. 
Smith,  of  Preston,  narrates  a  case  in  which  a  linseed  poultice  provoked 
the  symptoms  of  hay-asthma.  In  one  case  an  attack  was  alwa3's  induced 
by  porridge.  Simple  dust  will  occasionally  excite  these  symptoms,  and 
sometimes  one  kind  of  dust  only.  Thus,  a  middle-aged  man,  an  iron- 
monger, had  suffered  from  paroxysmal  coryza  and  asthma  for  two  years, 
the  attacks  being  brought  on  only  by  the  dust  of  his  shop;  Avhilst  other 
kinds  of  dust,  as  that  of  a  road,  failed  to  affect  him;  nor  did  flowers, 
grasses,  etc.,  nor  sunlight.  This  case  was  singular  in  this  respect,  that 
whilst  only  the  dust  of  his  shop  excited  coryza  and  asthma,  yet  in  certain 
localities  he  suffered  at  night  irom  simple  asthma  without  coryza.  Xot- 
withstanding  Mr.  Blackley's  careful  and  elaborate  experiments,  I  cannot 
help  believing  that  sunlight  and  great  heat  will  in  some  persons  bring  on 
an  attack  without  the  intervention  of  pollen.  I  have  known  persons  who 
could  never  look  at  the  sun  without  it  inducing  violent  sneezing.  It  is 
well  known,  of  course,  that  strong  sunlight  and  great  heat  will  much  ag- 
gravate the  attack  induced  by  poflen. 

The  itching  and  tingling  Avhich  generally  accompany  paroxysmal 
sneezing,  no  matter  Avhat  their  exciting  cause,  may  affect  the  whole  or  any 


ARSENIC.  221 

part  of  the  nose.  Sometimes  tlie  tingling  and  itching  are  felt  near  the 
orifice,  or  inside  under  the  bridge,  and  may  extend  to  the  cheek  or  to  the 
eyes,  how  and  then  only  to  the  inner  canthus, and  maybe  limited  to  this 
part,  or  they  may  affect  also  the  palate  or  throat.  I  remember  the  coryza 
in  one  case  was  accompanied  and  prob'ably  excited  by  itching  of  the  nose 
and  soft  palate,  and  that  iodine  inhalations  at  once  removed  the  coryza 
and  nasal  itching,  but  left  unaffected  the  itching  of  the  palate,  which 
ceased  at  once  on  the  application  of  a  little  nitrate  of  silver. 

It  is  interesting  to  observe  the  very  different  degrees  of  development 
of  the  disease.  In  certain  cases  the  attack  in  some  seasons  appears  to 
be  limiied  to  paroxysmal  severe  itching  of  the  inner  canthus.  In  other 
cases,  even  of  true  "  hay-fever,"  the  irritant  excites  only  this  itching  of 
the  inner  canthus ;  though  at  other  times  it  also  excites  paroxysmal  sneez- 
ing, or  the  attack  may  at  first  be  limited  to  the  itching,  but  as  it  goes  on 
sneezing  and  profuse  watery  discharges  are  superadded.  In  other  in- 
stances, besides  the  itching  and  sneezing,  the  i)atient  suffers  from  bron- 
chitis and  dyspnoea.  In  another  group  of  cases  the  irritant  only  excites 
bronchitis  and  dyspnoea.  In  yet  another  set  of  cases  a  patient  has  vio- 
lent attacks  of  sneezing,  generally  occurring  in  the  morning  without  any 
itching. 

Arsenic  in  many  of  these  cases  is  most  efficacious,  quickly  affording 
relief  in  some,  but  in  others  requiring  ten  days  or  a  fortnight  to  mani- 
fest its  remedial  effect,  while  in  yet  other  cases  it  altogether  fails.  I  find 
it  of  little  or  no  value  in  true  hay  fever,  that  is,  where  the  paroxysmal 
sneezing  is  excited  by  pollen.  Where  there  is  fever,  aconite  (see  x\.co- 
nite),  if  given  early,  curtails  the  course  of  the  attack  considerably.  Cases 
unyielding  to  arsenic  are  sometimes  benefited  by  iodine  inhalation,  by 
the  administration  of  iodide  of  potassium,  or  by  veratrum  viride.  The 
case  of  a  young  woman,  twenty-two  years  of  age,  who  for  several  years 
had  suffered  with  attacks  of  sneezing  like  those  described,  well  illustrates 
the  value  of  local  applications.  The  fits  occurred  in  the  morning,  lasted 
several  hours,  were  accompanied  by  considerable  pain  over  the  forehead, 
and  the  saeezing  was  so  violent  that  she  be-^ame  quite  exhausted,  and  so 
remained  the  greater  part  of  the  day.  She  complained  also  of  great  itch- 
ing over  the  whole  of  the  inside  and  outside  of  the  nose  and  part  of  the 
face,  which  continued  as  long  as  the  sneezing.  Her  health  was  failing 
her,  and  her  hair  was  growing  very  thin.  Arsenic  benefited  her  very 
slightly,  while  iodine  inhalations,  the  internal  administration  of  verat- 
rum viride,  pulsatilla,  iodide  of  potassium,  bromide  of  potassium,  and 
cod-liver  oil  were  found  useless.  Then  aconite  liniment  to  the  outside 
of  the  nose  and  itching  part  of  her  face,  immediately  subdued  the  attack, 
removing  both  the  itching  and  the  sneezing.  The  attacks  of  sneezing 
recurred  very  slightly,  and  a  fortnight's  persistence  with  the  treatment 
cured  them.  Cocaine  applied  to  the  nose  will,  in  most  cases,  cut  short 
an  attack,  and  some  patients  derive  benefit  by  snuffing  up  hazeline. 

The  changes  which  arsenical  compounds  undergo  in  the  stomach  are 
at  i:)resent  unknown.  There  is  no  proof  that,  like  most  other  metals, 
arsenic  combines  with  albumen  to  form  an  albuminate.  The  uniform- 
ity of  action  of  all  soluble  arsenical  compounds  renders  it  probable  that 
either  in  the  stomach  or  the  blood,  they  ultimately  become  identical  in 
composition.  Metallic  arsenic,  like  the  oxide,  is  poisonous;  it  is  proba- 
bly first  oxidized  before  it  becomes  active.  Pure  sulphide  of  the  metal 
is  inert,  but,  as  it  generally  contains  a  not  inconsiderable  quantity  of  the 
oxide  this  admixture  renders   it  poisonous. 


222  ARSENIC. 

The  condition  of  the  stomach  is  said  to  control  the  action  of  arsenic; 
for  example,  when  food  is  present,  the  medicine  becomes  absorbed  by  the 
lacteals,  and  throngli  them  mixed  with  tlie  blood,  while  if  the  stomach  is 
empty  the  arsenic  is  absorbed  by  the  veins,  and,  passing  into  the  liver,  is 
separated  with  the  bile. 

In  small  medicinal  doses,  arsenic  excites  a  sensation  of  warmth  at  the 
epigastrium,  and  gives  rise  to  a  sensation  of  hunger;  indeed  many  main- 
tain that  arsenic,  while  increasing  appetite,  promotes  digestion,  which 
others  as  strenuously  deny.  Arensic,  as  we  shall  see  hereafter,  by  remov- 
ing or  lessening  a  morbid  condition  of  the  stomach,  promotes  digestion  and 
appetite. 

In  certain  diseases  of  the  stoQiach  few  remedies  are  more  useful  than 
arsenic.  In  the  so-called  irritative  dyspepsia,  where  the  tongue  is  furred, 
and  its  papillse  red  and  prominent,  a  drop  of  the  sulution  of  arsenic,  taken 
shortly  before  food,  will  be  found  of  great  benefit.  Administered  in  the 
same  manner,  it  will  arrest  the  distressing  vomiting  of  drunkards  with 
almost  unfailing  certainty,  and  simultaneously  improve  the  state  of  the 
stomach,  and  restore  both  appetite  and  digestion.  This  vomiting,  accom- 
panied by  great  straining  and  distress,  usually  occurs  in  the  morning 
before  breakfast;  and  mostly  very  little,  and  sometimes  nothing,  is  ejected, 
and  then  it  is  called  dry  vomiting.  The  vomit  is  generally  intensely 
bitter,  sour,  and  of  a  green  color. 

Arsenic  is  valuable  in  chronic  ulcer  and  cancer  of  the  stomach,  allaying 
the  pain  and  checking  the  vomiting;  and  I  have  seen  this  metal  give  relief 
in  chronic  ulcer,  after  failure  of  the  commonly-used  remedies.  It  is 
sometimes  useful  in  the  vomiting  of  pregnancy. 

Arsenic  sometimes  removes  heartburn,  and  other  distressing  sensations 
of  the  stomach,  and  is  very  useful  in  gastralgia.  It  is  probable  that  some 
of  the  cases  reported  to  be  cured  by  arsenic  and  supposed  to  be  cases  of 
ulcer  of  the  stomach,  were  really  cases  of  gastralgia. 

Small  doses  of  arsenic  are  serviceable  in  that  form  of  chronic  vomiting, 
when,  after  eating,  the  patient  mostly  rejects  his  meal  without  pain,  and 
with  scarcely  any  naiisea,  the  food  simply  regurgitating  into  the  mouth. 

It  has  been  recommended  in  the  vomiting  of  cholera.  It  is  often 
useful  in  the  vomiting  of  pregnancy. 

The  solution  of  arsenic  is  always  of  service  in  that  form  of  chronic 
dyspepsia  and  diarrhoea  characterized  by  the  following  symptoms: — A 
sinking  at  the  pit  of  the  stomach,  which  is  relieved  by  food;  but  imme- 
diately on  taking  it,  nay,  even  during  mastication,  an  urgent  desire  seizes 
the  patient  to  relieve  the  bowels,  which  may  constrain  him  to  quit  the 
table.  The  motions  are  solid,  or  se}ni-solid,  usually  containing  lumps  of 
half -digested  food.  The  disease  appears  to  depend  on  excessive  peristaltic 
action  of  the  stomach  and  intestines  whereby  the  food,  before  it  is  di- 
gested, IS  driven  from  the  stomach  to  the  intestines,  and  thence  expelled. 
This  form  of  diarrluiea  is  common  with  children,  eight  or  twelve  years  of 
age,  and  may  last  many  months.  Arsenic  in  a  few  days  will  prolong  the 
interval  between  the  meal  and  the  evacuation,  and  in  a  week  or  ten  days 
the  disease  will  give  way.  I  always  give  one  or  two  drops  shortly  before 
each  meal.  (See  Opium.)  Arsenic  often  proves  useful  in  other  chronic 
forms  of  diarrhoea,  even  Avlien  due  to  serious  organic  disease,  as  the  bowel 
ulceration  of  phthisis,  etc. 

Arsenic  has  been  strongly  recommended  in  cholera;  especially  in  the 
later  stages,  when  there  is  much  collapse. 

Arsenic  enters  the  blood  freely,  but  the  effects  of  this  metal  on  it  are 


ARSENIC.  223 

unknown.  It  has  been  detected  not  only  in  tliis  fluid,  but  in  most  of  the 
organs  of  the  body. 

In  frogs,  according  to  Sklarek,  in  about  five  minutes  after  poisoning 
by  arsenic  acid,  the  animal  lies  flat,  with  extended  extremities  and  without 
breathing.  Pinching,  or  other  irritation,  excites  neither  reflex  action  nor 
voluntary  motion,  though  much  voluntary  power  remains,  since,  on  lift- 
ing the  animal,  or  withdrawing  a  leg,  or  turning  the  frog  on  its  back,  it 
displays  active  voluntary  movements.  In  a  short  time,  however,  the  animal 
becomes  completely  paralyzed.  Arsenic,  therefore,  paralyzes  first  sensation 
and  reflex  action,  and  some  time  afterwards  voluntary  power.  This  account 
of  Sklarek's  corresponds  Avith  my  observation  of  the  order  in  which  the 
symptoms  occur  after  poisoning  by  potash,  or  in  mechanical  arrest  of  the 
circulation  during  the  summer  months.  My  experiments  with  arsenious 
acid,  dissolved  with  the  aid  of  a  small  quantity  of  soda,  made  in  October, 
do  not  agree  Avith  Sklarek's  account;  for  I  found  that  sensation  and  reflex 
action  persisted  as  long,  or  longer,  than  voluntary  power. 

Sklarek  attributes  the  general  paralysis  to  the  action  of  arsenious  acid 
on  the  cord.  My  own  experiments,  conducted  with  Dr.  Murrell,  confirm 
this  statement;  but  they  show  also  that  arsenious  acid  is  a  paralyzer  of 
the  motor  and  sensory  nerves,  and  of  the  muscles;  in  fact,  like  potash, 
tartar-emetic  and  aconitia,  it  is  a  protoplasmic  poison,  destroying  the 
functional  activity,  first  of  the  central  liervous  system,  next  of  the  nerves, 
and  last  of  the  muscles. 

Arsenious  acid  quickly  arrests  the  heart  of  cats  and  frogs,  and  probably 
of  other  animals  when  administered  in  large  doses.  This  effect  is  due  to 
the  direct  action  on  the  heart;  for  arsenious  acid  arrests  the  frog's  heart 
when  removed  from  the  body.  As  arsenious  acid  is  a  protoplasmic  poison, 
I  suggest  that  it  stops  the  heart  by  alfecting  all  its  structures,  its  ganglia, 
its  nerves,  and  its  muscle.  Arsenious  acid  lowers  arterial  tension;  partly, 
it  is  thought,  by  its  influence  on  the  vaso-motor  nerves,  but  also  owing  to 
its  action  on  the  heart.  Bolim  and  Unterberger  find  that  arsenic  especi- 
ally reduces  arterial  pressure  in  the  abdominal  vessels. 

Lesser  concludes  from  his  experiments  that  paralysis  of  the  heart  is  preceded  by 
slight  and  transient  increased  irritabihty,  accelerating  the  heart's  beats  in  warm-blooded 
animals.  Large  doses,  however,  at  once  decrease  the  heart's  action,  and  the  blood- 
pressure  at  once  falls  in  the  aorta.  He  attributes  the  increased  frequency  of  the  pulse 
to  depression  of  the  vagi  and  stimulation  of  the  cardiac  ganglia.  The  depression  from 
large  doses  he  ascribes  to  depression  of  cardiac  ganglia  and  stimulation  of  vagi.  The 
vagi,  he  believes,  are  first  stimulated  and  then  depressed.  Arsenic,  he  finds,  does  not 
affect  the  accelerator  nerves,  nor  the  vaso-motor  centre,  nor  vaso-motor  nerves,  nor  the 
muscidar  tissues  of  the  vessels. 

Arsenic  at  first  stimulates,  but  larger  doses  soon  extinguish  the  irritability  of  the 
respiratory  centre.  The  primary  stimulation  is  never  great.  Small  dosgs  stimulate 
the  terminations  of  the  pulmonary  vagi.  Arsenic  increases  peristalsis  of  the  intestines 
by  direct  action  on  the  ganglia  in  the  intestinal  walls. 

He  finds  also  that  arsenic  diminishes  the  irritability  of  the  motor  nerves  and  mus- 
cles, and  first  stimalates  and  then  paralyzes  the  spinal  cord.  His  experiments,  then, 
for  the  most  part  confirm  my  conclusions  that  arsenic  is  a  protoplasmic  poison;  but 
he  finds  tliat  it  first  sliglitly  and  transiently  stimulates  many  structures. 

Dr.  Murrell  and  I  noticed  that  in  ten  to  twenty  minutes  after  injecting 
a  small  quantity  of  arsenic  under  the  skin  of  a  frog  the  animal  gapes, 
keeps  its  mouth  open,  and  sometimes  puts  its  paws  into  its  mouth;  it 
looks  as  if  sick,  and  some  frogs  actually  vomit.  Arsenic,  therefore,  acts 
as  an  emetic  to  frogs. 

Dr.  Murrell  and  I  were  astonished  to  find  how  very  fatal  arsenious 


224  ARSENIC. 

acid  is  to  frogs,  for  ^of g-o  ^^  ^^^^  weiglit  of  the  animal  produced  complete 
paralysis  in  lOS  minutes,  and  ^jroTTo  killed  the  frog  on  the  third  day.  \Ve 
found  that  frogs  are  much  more  influenced  by  arsenious  acid  dissolved  in 
a  small  quantity  of  soda  than  by  arseniate  of  soda;  one-fifth  of  a  grain  of 
arseniate  of  soda  requires  eleven  hours  to  produce  complete  paralysis. 

The  statonents  as  to  the  effects  of  arsenic  when  taken  for  a  prolonged 
period  are  sti-angely  conflicting;  yet  probably  all  are  true,  though  at 
present  it  is  impossible  to  reconcile  the  opposing  statements. 

Some  animals,  as  the  horse  and  sheep,  can  take  considerable  quantities 
of  arsenic,  not  only  without  harm,  but  with  apparent  benefit. 

It  is  now  established  beyond  reasonable  doubt,  that  in  some  parts  of 
Lower  Austria,  as  Styria,  many  of  the  inhabitants  are  accustomed  to  take 
considerable  quantities  of  arsenic,  sometimes  as  a  condiment  with  food. 
It  is  said  they  often  eat  it  with  cheese.  They  usually  begin  with  a  small 
dose,  once  or  twice  a  week,  the  quantity  being  gradually  increased,  until 
half  a  grain,  or  a  grain,  or  even  more,  is  taken  at  one  time.  This  habit 
seems  to  induce  no  untoward  symptoms.  Arsenic  is  eaten  for  a  twofold 
purpose.  The  women,  and  even  the  men,  take  it  to  clear  the  complexion, 
and  to  improve  the  personal  appearance;  and  it  is  said  to  effect  these 
objects.  The  men  more  frequently  use  it  to  enable  them  to  undergo 
great  exertion  without  fatigue,  and  they  maintain  that  it  enables  them  to 
climl)  mountains  and  accomplish  fatiguing  tasks,  impossible  to  accomplish 
without  it.  The  experience  of  most  countries  is  opposed  to  the  Styrian 
practice;  for  it  is  generally  found  that  the  long-sustained  administration 
of  arsenic  fails  to  niduce  tolerance  of  the  drug,  but,  on  the  contrary, 
entails  serious  consequences.  Even  in  the  arsenic-eating  countries,  the 
habit  is  not  without  risk;  for  there  it  is  a  general  opinion  that  many  fall 
victims  to  the  drug.  It  has  been  supposed  that,  taken  in  an  insoluble 
form,  the  arsenic  is  not  absorbed  at  all,  but  passes  out  with  the  motions, 
leaving  the  system  unaffected  by  it;  but  Dr.  Maclagan's  investigations 
effectually  disposed  of  this  supposition,  for  after  witnessing  a  Avell-known 
arsenic-eatei  eat  arsenic  and  afterwards  collecting  his  urine,  a  considera- 
ble quantity  of  the  poison  was  obtained  from  it. 

Ordinary  experience,  however,  shows  that  the  long-continued  use  of 
arsenic  produces  serious  symptoms,  evidenced  first  in  the  eyes  and  stomach. 
The  eyelids  become  slightly  oedematous,  the  lower  before  the  upper; 
while  usually  at  the  same  time,  or  soon  after,  slight  conjunctivitis  occurs 
with  suffusion  and  smarting  of  the  eyes,  and  sometimes  dimness  of  sight. 
The  mucous  membrane  of  the  nose,  mouth  and  throat  may  be  reddened 
and  inflamed,  giving  rise  to  thirst  and  dryness  of  the  mouth  and  throat. 
In  some,  the  digestion  becomes  deranged  nnich  sooner  than  in  others.  The 
appetite  fails,  and  at  the  pit  of  the  stomach  a  sensation  of  weight  or  sore- 
ness is  felt,  aggravated  each  time  on  taking"  food  or  the  arsenic.  Some- 
times the  stomach  is  affected  before  the  eyes.  On  the  appearance  of  any 
of  these  symptoms  the  drug  must  be  given  in  smaller  quantities,  or  be 
discontinued.  The  skin  becomes  dry  and  dirty-looking,  and  a  slight 
"branniness"  maybe  noticed,  most  marked  where  the  skin  is  covered 
with  clothes.  Eczema  or  urticaria  may  arise,  or  perhaps  vesication  or 
mere  desquamation  with  tenderness  of  the  palms  of  the  hands  or  soles  of 
the  feet.  Arsenic  is  said  to  have  produced  pityriasis  and  lichen  and  aching 
pains  in  the  head,  and  swelling  and  inflammation  of  the  joints.  Sleep 
may  be  much  broken,  or  disturbed  by  dreams.  Still  more  serious  symp- 
toms set  in.     The  voice  becomes  rough,  and  in  some  cases  salivation  takes 


AESENIC.  225 

place.  Ulcers  may  form  in  the  mouth.  Nausea,  vomiting,  and  diarrhoea 
set  in  with  slimy  and  bloody  motions,  voided  with  much  straining  and 
pain.  The  hair,  and  even  the  nails,  sometimes  fall  olf.  Cough  with 
bloody  expectoration,  may  occur.  With  these  serious  symptoms  the 
patient  wastes  away,  the  skin  becomes  dry  and  hot,  the  pulse  frequent, 
especially  at  night.  Pains  in  the  limbs,  neuralgic  pains,  anaesthesia, 
tremblings,  and  even  paralysis,  come  on;  till  at  last  the  memory  fails, 
sensation  is  lost,  and  death  soon  follows.  The  susceptibility  to  arsenic 
varies;  some  being  speedily  affected  by  two-drop  doses  of  the  arsenical 
solution,  while  others  can  take  ten  to  tAventy  drops  without  injury  for  a 
considerable  time. '  Dr.  McCall  A.nderson  states  that  patients  while  taking 
arsenic  are  liable  to  bronchitis,  and  should  therefore  be  cautioned  against 
exposure  to  cold. 

In  some  persons  very  small  doses  inhaled  for  a  long  time  will  induce 
serious  symptoms,  and  many  cases  are  recorded,  where  serious  symptoms 
arose  from  the  use  of  wall  papers  whose  pigments  contained  arsenic. 
Arsenic  is  largely  used  in  the  formation  of  pigments  other  than  green. 
Arsenical  pigments  are  largely  used  in  cretonnes, 

Gies  finds  that  the  prolonged  use  of  arsenic  in  increasing  doses  con- 
tinued for  months,  has  the  same  effect  on  the  bones  of  rabbits,  pigs  and 
fowls,  as  phosphorus.  The  bones  become  more  compact;  these  changes 
beginning  in  about  three  weeks.  The  animals  became  heavier  and  fatter, 
and  there  occurred  fatty  degeneration  of  the  heart,  liver,  kidneys,  and 
spleen. 

A  large  dose  induces  the  symptoms  of  acute  poisoning.  The  arsenic 
acts  as  an  irritant  to  the  whole  digestive  canal,  exciting  very  active  in- 
flammation in  its  delicate  mucous  membrane;  accordingly  the  symptoms 
to  be  expected  from  severe  inflammation  of  this  tract  set  in.  But,  strange 
to  say,  the  symptoms  following  a  large  poisonous  dose  are  not  invariable; 
the  symptoms  arising  from  acute  inflammation  of  the  digestive  canal  are 
most  common,  and  prove  fatal  in  four  or  five  days;  but  sometimes  the 
symptoms  are  almost  or  entirely  absent,  and  instead  of  the  patient  running 
the  usual  course  of  arsenical  poisoning,  profound  coma  sets  in,  from  which 
he  never  wakes,  but  dies  in  a  few  hours,  the  mucous  membrane  of  the 
stomach  and  intestines  being  free  from  all  inflammation.  Sometimes  the 
symptoms  are  very  like  those  of  English  cholera. 

At  the  post-mortem  the  intestines  are  filled  with  rice-water  fluid,  with 
epithelial  flakes,  the  epithelium  being  in  a  state  of  advanced  fatty  de- 
generation.    The  solitary  and  agminated  glands  are  much  swollen. 

Dr.  Biachez  describes  another  form  of  arsenical  poisoning  character- 
ized by  choleraic  symptoms  of  the  intestinal  canal,  with  suppression  of 
urine,  cramps,  and  progressive  coldness  of  the  body,  convulsions,  and 
localized  paralysis  especially  attacking  the  extensors.  If  the  patient 
survives  long  enough,  a  petechial,  papular,  vesicular  and  wheal-like  rash 
often  appears  from  the  second  to  the  fifth  day. 

A  fatal  does  of  arsenic  lowers  the  temperature  of  dogs  and  rabbits 
4°  to  7°  Fah. 

Even  when  injected  into  the  blood,  or  applied  to  a  wound,  arsenic 
produces  its  local  effects  on  the  digestive  canal,  being  found  in  the  intes- 
tines, showing  that  this  is  one  outlet  by  Avliich  the  poison  is  eliminated. 
When  the  metal  is  injected  into  the  blood,  or  absorbed  by  a  wound,  the 
effects  on  the  stomach  and  intestines  are  said  to  be  as  severe  as  when  it  is 
swallowed.  This  is  perhaps  hardly  true.  It  is  evident  from  the  foregoing 
15 


2l>(;  AESENIC. 

facts  that  arsenic  manifests  an  especial  affinity  for  the  mucous  membrane 
of  the  intestinal  canal. 

The  post-mortem  examination  in  acute  arsenical  poisoning  shows  much 
inflammation  of  the  stomach,  often  in  patches,  in  which  arsenic  powder 
is  visible,  embedded  in  the  thick  viscid  mucus.  Spots  of  ecchymosis  are 
sometimes  seen,  and  less  commonly  ulcerations.  Perforation  is  rare. 
The  oesophagus  and  intestines  may  undergo  inflammation,  often  most 
severe  in  the  rectum.  Occasionally  the  mouth,  throat,  and  even  windpipe 
and  bladder,  become  inflamed.  The  curious  fact  has  been  pointed  out, 
that  notwithstanding  the  existence  of  symptoms  of  inflammation,  yet 
sometimes  no  traces  of  it  are  apparent  after  death.  This  al)sence  of  in- 
flammation cannot  be  explained  by  want  of  time  for  the  arsenic  to  act; 
for  in  cases  ending  in  death  yet  more  rapidly,  severe  structural  changes 
are  to  be  found.  Death  may  occur  in  two  hours.  Ecchymosis  is  com- 
monly met  with  under  the  lining  of  the  cavities  of  the  heart,  and  if  the 
patient  survives  long  enough,  a  petechial,  papular,  or  pustular  rash,  or 
wheals  of  urticaria  may  occur.  Neuralgic  pains,  anesthesia,  and  paralysis 
are  sometimes  seen.  Like  phosphorus,  it  produces  extreme  fatty  de- 
generation of  the  liver,  heart,  kidneys,  and  other  structures.  Ether,  and 
even  chloroform  are  said  to  jiroduce  similar  effects.  Both  in  arsenical 
and  antimonial  poisoning  the  glycogenic  function  of  the  liver  is  said  to 
be  destroyed.     Arsenic  retards  putrefaction. 

Drs.  Cutler  and  Bradford,  from  their  experiments  conducted  accord- 
ing to  Malassez's  method,  are  led  to  conclude  that  "arsenic  given  in 
health  causes  a  progressive  decrease  of  the  number  of  the  red  and  especi- 
ally of  the  white  corpuscles.  In  simple  anemia,  on  the  contrary,  there 
seems  to  be  an  increase  at  first  of  both  red  and  white  corpuscles.  After 
a  certain  point  there  is  a  steady  diminution  of  both."  Arsenic  is  useful 
in  chlorosis  and  ana?mia,  sometimes  succeeding  when  iron  fails  and  dis- 
agrees. Some  hold  that  the  addition  of  arsenic  increases  the  efficacy  of 
iron.  It  is  the  most  successful  remedy  in  pernicious  antemia,  and  some 
recommend  it  in  leucocythajmia  and  lymphadinosis.  Large  doses  will, 
in  some  cases,  entirely  reduce  the  excess  of  white  corpuscles  in  leucocy- 
thffimia,  but  apparently  have  little  influence  in  increasing  the  quantity 
of  red  corpuscles.  Arsenic,  in  moderate  doses,  it  is  said,  gives  fulness 
and  increased  strength  to  the  pulse.  Some  give  arsenic  in  prostrating 
acute  febrile  diseases,  with  the  effect,  so  they  aver,  of  strengthening  the 
pulse,  moistening  the  skin,  and  invigorating  the  patient.  Arsenic  is 
useful  for  the  swelled  feet  of  old  or  wenkly  persons;  or  for  old  j^eoi^le 
with  a  weakly  acting  heart  and  feeble  circulation,  who  often  suffer  from 
breathlessness  on  exertion. 

Arsenic  has  long  been  recommended  as  an  excellent  remedy  in  spas- 
modic diseases  of  tlie  lungs;  it  is  often  useful  in  asthma,  whether  or  not 
dependent  on  emphysema. 

Arsenic  often  gives  great  relief  to  a  class  of  emphysematous  persons 
who,  on  catching  cold,  are  troubled  with  a  slight  Svheezing  at  the  chest, 
difficulty  of  breathing,  especially  on  exertion,  or  at  night  time,  and  are 
obliged  to  be  partially  propped  up  in  bed;  it  appears,  however,  to  be  of 
little  service  when  there  is  very  much  bronchitis,  or  when  the  paroxysms 
of  dyspnoea  are  very  urgent.  In  this  contingency  lobelia  or  belladonna 
answers  better.  Arsenic  is  especially  useful  in  the  foregoing  cases,  where 
the  difficulty  of  breathing  can  be  connected  with  the  retrocession  of  a  rash, 
as  eczema.  Arsenic  generally  relieves  the  wheezing  with  oppressed 
breathing,  which  affects  some  children  for  months  and  even  years,  and  is 
probably  tlie  commencement  of  asthma. 


ARSENIC.  227 

Arsenic  lessens  the  carbonic  acid  of  respiration. 

The  beneficial  influence  of  arsenic  in  certain  skin  diseases,  particularly 
in  the  scaly  eruptions  and  in  chronic  eczema,  is  universally  recognized. 
Lepra  almost  always  yields  to  it,  and  its  efficacy  over  other  forms  of 
psoriasis  is  hardly  less  marked.  Many  cases  it  cures,  others  it  improves, 
but  a  few  it  leaves  unbenefited. 

Hunt,  who  has  had  more  experience  of  this  remedy  than  perhaps  any 
other  person,  laid  down  excellent  rules  for  guidance.  He  recommends 
small  doses  as  capable  of  effecting  all  that  is  possible  by  arsenic,  and  dis- 
countenances the  practice  of  gradually  increasing  the  dose.  If  toxical 
effects  arise  he  advises,  not  the  discontinuance  but  the  diminution  of  the 
dose. 

Arsenic  is  hurtful  during  the  inflammatory  stages  of  eruptions. 

Children  above  tive  years  will  bear  a  dose  nearly  as  large  as  adults;  and  it  is  curi- 
ous that  girls  often  require  a  larger  dose  than  boys. 

The  largest  dose  ever  required  is  five  minims,  repeated  three  times  a  day;  but  some 
practitioners  give  double  or  even  treble  this  quantity.  As  a  rule  it  should  never  be 
given  on  an  empty  stomach. 

Arsenic,  if  mixed  with  food,  does  not  usually  irritate  the  bowels.  In  the  course  of 
a  few  days  or  weeks  it  will  produce  an  itching  or  smarting  in  the  conjunctiva,  and 
this  membrane  will  appear  slightly  inflamed,  the  lower  eyelid  becoming  a  little  puffed 
or  swollen  at  this  point.  The  cutaneous  disease  will  now  begin  to  decline,  and  the  dose 
must  be  reduced  one-fifth. 

Should  the  conjunctiva  continue  much  inflamed,  the  dose  must  be  still  further 
reduced,  but  the  conjunctiva  should  be  kept  affected  throughout  the  whole  course. 

If  the  skin  become  more  inflamed,  the  course  must  not  be  interrupted,  but  an  occa- 
.  sional  aperient  must  be  taken. 

The  arsenical  treatment  must  be  continued  for  as  many  months  after  the  final  dis- 
appearance of  the  eruption  as  it  has  existed  years  before. 

These  rules  closely  correspond  to  the  advice  given  by  Dr.  Graves  in 
his  clinical  lectures.  "With  two  statements  made  in  this  "  code  of  regula- 
tions," my  experience  does  not  quite  correspond,  for  I  have  not  found 
that  smarting  of  the  eyes  and  swelling  of  the  lower  lid  occur  so  often  as 
IMr.  Hunt  implies,  nor  do  I  find  it  necessary  to  induce  these  toxic  symp- 
toms to  insure  the  beneficial  influence  of  the  remedy. 

The  first  influence  of  arsenic  on  psoriasis  is  to  make  it  redder,  more 
inflamed,  and  to  look  worse  than  before  treatment,  a  fact  which,  if  not 
known,  would  lead  to  the  suspension  of  the  drug  just  when  it  commenced 
to  do  good;  but  the  exaggerated  redness  soon  declines,  the  eruption  heals 
in  the  centre,  leaving  in  a  short  time  only  a  slight  redness. 

Chronic  eczema,  although  perhaps  not  so  amenable  to  arsenic  as  psori- 
asis, is  generally  benefited  Ijy  it,  especially  the  obstinate  chronic  forms. 
It  sometimes  removes  the  rebellious  eczema  which  infests  the  vulva,  the 
verge  of  the  anus,  and  the  scrotum. 

Arsenic  will  generally  cure  that  troublesome  disease  pemphigus,  as 
Mr.  Hutchinson  has  shown;  and  although  after  a  variable  interval  the 
eruption  is  liable  to  recur,  it  will  again  yield  to  a  renewed  course  of  the 
drug. 

Arsenic  sometimes  relieves  lichen  and  other  obstinate  skin  affections. 

In  our  experiments  on  arsenious  acid  and  tartar-emetic,  published  in 
the  Journal  of  Phi/siologi/  for  1878,  Dr.  Murrell  and  I  found  that  these 
two  substances  produced  desquamation  in  frogs.  Thus,  after  poisoning 
by  arsenious  acid,  even  with  only  ^ ,.  ^  o  „  part  of  the  weight  of  the  animal, 
desquamation  begins  on  the  trunk  in  about  five  hours,  in  the  legs  in  about 
eight  hours.     The  cuticle  strips  off  in  large  pieces,  so  readily  that  mere 


228  ARSENIC. 

handling  the  animal  detaches  it.  Tartar-emetic  affects  the  cuticle  appar- 
ently in  a  somewhat  different  way;  it  changes  the  cuticle  into  a  pulp  or 
jelly,  so  that  even  whilst  the  frog  is  alive  it  can  be  scraped  but  not  torn 
off.  We  conclusively  showed  that  these  effects  are  due  to  the  direct 
action  of  arsenious  acid  and  tartar-emetic  on  the  skin. 

Does  arsenious  acid  affect  all  epithelial  structures  in  this  way  ?  I  think 
so.  Miss  Nunn  has  shown  that  it  affects  the  cornea.  And  after  acute 
poisoning  the  bow^els  are  found  filled  with  a  rice-water  fluid,  consisting  of 
epithelial  flakes,  and  the  epithelial  cells  are  choked  wnth  granules,  and 
some  in  a  state  of  advanced  fatty  degeneration,  and  these  changes  occur 
even  when  the  poison  is  injected  into  a  vein. 

Miss  A.  Xunn,  Lecturer  on  Biology  in  the  Wellesley  College,  Boston, 
U.  S.  A. ,  under  the  direction  of  Dr.  Michael  Foster,  kindly  investigated 
microscopically  the  action  of  arsenious  acid  and  of  tartar-emetic  on  the 
skin.  Miss  Xunn  shows  that  the  peculiar  effect  of  these  substances  is 
limited  to  the  epidermis  and  leaves  unaffected  the  corium,  with  the  ex- 
ception of  increasing  the  quantity  of  blood  it  contains.     Miss  Nunn  says: 

"An  examination  of  a  series  of  sections  taken  from  different  parts  of 
the  body  at  different  intervals  after  the  (hypodermip)  introduction  of  the 
poison,  "shows  that  the  general  effect  of  arsenious  acid  on  the  epidermis  is 
to  cause  a  degeneration,  and  partial  solution,  of  the  protoplasm  of  the 
cells,  Avhereby  (1)  the  whole  epiderm  becomes  loosened  from  the  subja- 
cent derm,  (2)  the  cells  of  the  malpighian  become  incoherent,  so  that  the 
whole  layer  collapses,  and  its  well-known  architectural  features  become 
obseurcdj  and  (3)  the  intermediate  layer  separates  from  the  malpighian 
laver  below,  and  at  times  from  the  corneous  layer  above.  The  corneous 
and  intermediate  layers  are  th"s  desquamated,  sometimes  separately,  some- 
times, and  perhaps  most  frequently,  together.  In  no  case,  even  in  those 
of  most  extreme  or  most  lengthened  poisoning,  have  I  ever  seen  the  mal- 
pighian layer  actually  cast  off  during  life;  it  always  remains  attached, 
though  loosely,  to  the"  derm  in  a  manner  which  I  shall  presently  describe. 
In  preparing  sections,  however,  it  frequently  becomes  wholly  detached. 

"  It  is  obvious  from  the  foregoing  account  that  the  arsenic  first  attacks 
the  lowermost  or  innermost  portions  of  the  epiderm,  and  that  its  action 
advances  from  the  derm  outwards.  This  may  be  in  part  due  to  the  simple 
fact  that  the  innermost  cells  are  those  which  are  nearest  to  the  blood- 
vessels carrying  the  poison;  but  this  can  hardly  be  the  whole  reason,  since 
diffusion  must  be  very  rapid  tbrough  a  thin  membrane  of  such  a  nature 
as  the  epidermis.  It  seems  more  natural  to  attribute  the  phenomena  to 
the  fact  that  the  cells  of  the  malpighian  layer  next  to  the  derm  (the  colum- 
nar layer)  are  composed  of  more  active,  more  irritable  protoplasm  than 
that  of  the  rest  of  the  derm,  the  irritability  diminishing  in  the  series  of 
cells  from  within  outwards  in  proportion  as  the  metamorphosis  of  the 
protoplasm  into  keratin  becomes  more  and  more  pronounced. 

"  I  never  observed  any  excess  in  the  fluids  excreted  by  the  skin  gener- 
allv  as  the  result  of  arsenic  poisoning,  and  it  is  impossible  to  explain  the 
changes  described  above  as  merely  due,  or  as  chiefly  due,  to  an  excessive 
discharge  of  fluid  from  the  cutaneous  blood-vessels  or  lymphatics  loosen- 
ing and  separating  the  cells.  All  the  facts  go  to  prove  that  the  changes 
are  the  result  of  the  arsenic  acting  directly  on  the  epidermic  cell,  which 
Avith  its  diminished  cell-substance  and  shrunken  nucleus,  presents  a  strik- 
ing analogy  with  the  secreting  cell  (of  a  salivary  gland)  Avhicli  has  ])een 
stimulated' to  exhaustion;  and  I  shall  probably  not  go  far  Avrong  in  regard- 


ARSEisric.  229 

ing  the  changes  of  the  former  as  the  consequences  of  an  action  of  the  poi- 
son not  wholly  unlike  an  excessive,  in  fact,  a  lethal  stimulation,  by  which 
the  destructive  stages  of  the  metabolism  of  the  cells  are  hurried  on  beyond 
the  reparative  power  of  the  constructive  stages. 

"  The  stimulation  is  obviously  of  a  peculiar  kind.  One  marked  effect 
of  the  stimulation  of  undifferentiated  protoplasm  is  to  forward  and  accel- 
erate processes  of  growth.  I  have  looked  diligently  for  indications,  such 
as  double  nuclei,  etc.,  of  multiplications  in  the  epidermic  cells,  but  always 
in  vain.  One  would  naturally  expect  that  the  changes  which  I  had  de- 
scribed would,  if  the  animal  lived  and  recovered  from  the  poison,  be  fol- 
lowed by  a  rapid  renewal  of  the  epidermis,  but  I  have  not  as  yet  suc- 
ceeded in  xeeping  the  animals  long  enough  to  see  even  the  first  trace  of 
it.  I  may  remark  incidentally,  that  the  fact  of  the  columnar  layer  being 
the  first  to  be  attacked  by  the  poison  may  perhaps  be  regarded  as  an  indi- 
cation that  the  growth  of  the  epidermis  does  take  place  from  this  layer, 
and  not,  as  recent  researches  on  the  structure  of  the  mammalian  epiderm 
have  suggested,  from  the  cells  of  the  intermediate  part. 

"  The  characteristic  vertical  arrangement  of  the  undermost  cells,  the 
columnar  layer  of  the  epiderm,  is  a  phenomenon  for  which  it  is  very  diffi- 
cult to  account.  Embryologically  considered,  this  feature  seems  to  be  a 
continuation  of  the  condition  of  the  primary  epiblast,  the  cells  of  which 
are  always  vertical;  but  it  is  difficult  to  see  what  purpose  is  served  by  the 
preservation  of  this  ancestral  feature.  It  is  obvious,  however,  from  the 
results  which  I  have  given,  that  this  vertical  position  is  maintained  (for 
whatever  reason)  by  some  exertion  of  the  protoplasm  of  the  constituent 
cells.  Immediately  that  the  arsenic  damages  the  protoplasm,  the  vertical 
arrangement  is  lost:  indeed  this  is  the  most  obvious  effect  of  the  arsenic, 
and  the  one  most  readily  recognized." 

Concerning  the  action  of  antimony  she  says:  ''  The  structural  changes 
in  the  epidermis  brought  about  by  antimony  are  essentially  the  same  as 
those  produced  by  arsenic.  There  is  (1)  the  same  marked  degeneration 
and  partial  solution  of  the  columnar  layer  which  causes  the  e^iidermis  to 
be  held  less  firmly  to  the  dermis;  though  previous  to  the  hardening,  the 
extreme  softness  of  the  cells  prevents  it  from  being  stripped  away  as  can 
be  done  in  the  case  of  arsenic.  There  is  (2)  the  same  degeneration  and 
separation  of  all  the  cells  of  the  malpighian  layer,  and  (3)  the  same  des- 
quamation of  the  corneous  and  intermediate  layers.  The  principal  differ- 
ence is  the  greater  softness,  or  more  complete  isolation  of  the  cells,  and 
the  somewhat  more  marked  change  in  the  intermediate  layer.  The  cells 
of  this  layer  appear  more  thoroughly  detached  from  one  another,  and 
hence  cavities  are  more  frequently  found  between  them:  but  their  proto- 
plasm is  never  formed  with  threads  and  processes  enclosing  spaces,  as  in 
the  columnar  cells.  It  is  this  separation  of  the  constituent  cells  of  the 
intermediate  and  also  of  the  malpighian  layer  which  is  the  chief  determin- 
ing cause  of  the  pulpy  or  mucilaginous  condition  of  skin  in  antimony  poi- 
soning mentioned  by  Ringer  and  Murrell.  Altogethei*,  the  action  of 
antimony  is  more  rapid  than  that  of  arsenic,  and  the  changes  produced 
by  it  bear  evidence  of  more  violence.  But  the  marked  change  in  the 
columnar  cells  remains  the  most  characteristic  feature  among  the  struc- 
tural changes  produced  by  both  arsenic  and  antimony  poisoning. 

"  Both  these  drugs,  then,  have  a  specific  effect  upon  the  cells  of  the 
epidermis,  the  one  differing  slightly  only  from  the  other  in  their  funda- 
mental action,  though  the  results  appear  to  the  naked  eye  to  diverge  so 


230  AKSENIC. 

largely.  The  skin,  under  the  influence  of  either  drug,  presents  a  striking 
contrast  to  one  which  has  been  left  to  disintegrate  in  a  natural  manner 
after  death.  I  have  examined  the  skin  of  frogs  at  intervals  of  one  to 
seven  days  after  death,  but  I  have  never  observed  the  peculiar  changes 
which  I  have  described  above  as  taking  place  in  the  columnar  cells.  The 
cells  of  the  whole  epidermis  become  granular  and  more  opaque,  and  the 
outlines  of  the  cells  become  indistinct;  the  corneous  layer  may  be  thrown 
off,  and  the  features  of  the  malpighian  layer  become,  eventually,  very  diffi- 
cult to  recognize;  but  at  no  stage  does  either  the  protoplasm  of  the  cells 
become  softened  in  the  peculiar  manner  described,  nor  do  the  nuclei 
become  shrunken.  The  desquamation  under  antimony  and  arsenic  is 
obviously  a  specific  effect."  Miss  K^unn  finds  that  arsenious  acid  and 
tartar-emetic  affect  the  cornea  in  a  similar  manner  to  the  skin,  but  the 
effects  are  never  so  marked  as  in  the  skin.  It  is  interesting  to  observe 
how  these  exjjeriments  confirm  the  conclusions  previously  arrived  at  by 
clinical  study.  These  investigations  show  that  arsenic  affects  the  epi- 
dermis mainly,  if  not  exclusively,  and  leaves  the  dermis  unaffected.  Dr. 
Duhring,  in  Wood's  "  Therapeutics,"  says  that  diseases  affecting  the 
more  superficial  parts  of  the  skin  are  most  amenable  to  the  influence  of 
arsenic,  and  that  it  possesses  little  or  no  influence  ujjon  diseases  seated 
in  the  deeper  structures  of  the  skin.  It  has  no  effect  upon  infiltrations 
of  the  corium.  If  long  continued,  arsenic  turns  the  skin  a  dirty  brown, 
and  this  discoloration  is  especially  marked  around  the  orifices  of  the  hair 
follicles.     The  color  is  very  like  the  discoloration  of  Addison's  disease. 

Few,  if  any,  remedies  are  so  successful  in  chorea  as  arsenic.  If  there 
is  much  anaemia,  iron  is  required;  if  fever  or  rheumatism,  these  must  be 
subdued  by  appropriate  treatment.  But  in  simple  uncomplicated  cases  of 
chorea,  arsenic  is  far  the  best  remedy.  Its  occasional  non-success  is  some- 
times owing  to  the  undue  smallness  of  the  dose,  and  decided  improvement 
often  begins  simultaneously  with  a  freer  administration  of  the  medicine. 
When  chorea  has  resisted  smaller  quantities,  children  may  take  four,  five, 
or  more  minims  of  the  solution.  In  one  case  which  rapidly  improved,  I 
quickly  increased  the  dose  till  the  boy  took  twenty  minims  of  liquor  arsen- 
icalis  six  times  a  day,  and  in  another  successful  case  the  girl  took  fifty 
minims  of  liquor  daily.  Dr.  Seguin  gives  two  to  five  minims  at  first  and 
quickly  increases,  adding  a  drop  to  each  dose  daily.  If  arsenical  symp- 
toms arise,  he  intermits  the  arsenic  for  forty-eight  hours.  He  finds  that 
with  most  patients,  doses  of  20,  25  or  30  drops  thrice  a  day  may  be 
reached.  Perrorid  uses  arsenic  hypodermically  with  great  success.  Arse- 
nic is  well  borne  this  way  and  does  not  derange  the  stomach. 

Arsenic  is  often  useful  in  neuralgia.  Dr.  Anstie  speaks  highly  of  it 
in  various  neuralgias;  and  in  angina  pectoris,  a  disease  he  regarded  as  a 
neuralgia,  he  states  that  it  will  lessen  the  severity  of  the  attacks,  and  in 
time  reduce  them  to  mere  "  tightness  of  the  chest." 

Arsenic  has  been  found  serviceable  in  epilepsy.  It  not  unfreqnently 
ciires  dull  throbbing  pain  affecting  one  brow. 

With  the  exception  of  quinia,  no  drug  subdues  intermittent  fever  like 
arsenic.  Some  indeed,  with  large  experience,  count  arsenic  equal,  if  not 
superior,  to  bark  in  ague.  The  greater  number  of  observers,  however, 
do  not  credit  arsenic  with  such  pre-eminent  virtues,  maintaining  that  cin- 
chona cures  tlie  disease  more  quickly  and  more  certainly,  and  that  it  is 
especially  to  be  preferred  in  those  malignant  forms  which,  unless  at  once 
arrested,  speedily  destroy  life.  A  concurrence  of  testimony  tends  to  show 
that  arsenic  is  most  useful  in  long-standing  agues,  especially  of  the  quar- 
tan type. 


ARSENIC.  231 

A  long-continued  course  of  arsenic  is  recommended  in  epithelioma, 
and  even  scirrluis  and  rodent  ulcer. 

Arsenic  has  lately  been  extolled  in  phthisis  and  tuberculosis.  It 
improves  the  apjjetite,  increases  assimilation,  lessens  expectoration  and 
cough,  and  promotes  the  cicatrization  of  cavities.  It  is  stated  that  it 
will  reduce  the  temperature  in  tuberculosis,  and  after  carefully  investiga- 
ting this  subject,  I  am  inclined  to  believe  so;  at  least  I  have  frequently 
observed  a  steady  and  sustained  fall  of  the  thermometer  follow  the  use  of 
arsenic  in  cases  when  the  undue  temperature  had  continued  unchanged 
for  a  considerable  time,  and  this  I  have  known  happen  twice  or  three 
times  in  the  same  case  on  reverting  to  arsenic  after  it  had  been  discon- 
tinued. The  decline  generally  takes  place  gradually,  and  may  begin  soon 
after  taking  the  arsenic,  or  the  fall  may  be  postponed  for  ten  or  twelve 
days.  Moreover,  I  have  seen  children  in  a  hopeless  state,  with  severe 
tuberculosis  involving  lungs,  intestines,  and  peritoneum,  steadily  and 
slowly  improve  and  ultimately  recover  under  arsenic  treatment,  and  I 
have  observed  a  like  result  in  adults  with  phthisis,  in  the  subacute  and 
chronic  forms.  It  must,  however,  be  admitted  that  this  is  a  very  intricate 
subject,  seeing  how  irregular  a  course  the  fever  of  tuberculosis  runs,  and 
how  sometimes  cases  the  most  desperate  recover  by  means  of  other  treat- 
ment, or  indeed  through  little  or  no  treatment.  Still,  I  am  sure  that  the 
action  of  arsenic  in  phthisis  and  tuberculosis  is  well  worthy  investigation. 
In  my  experience  it  is  especially  useful  in  fibroid  phthisis  and  chronic 
phthisis  with  much  fibroid  induration.  I  have  generally  given  from  two 
to  four  minims  every  two  to  four  hours.  In  a  few  cases  it  is  ill-borne, 
producing  sickness,  pain  in  the  stomach  and  bowels. 

Arsenic  is  often  serviceable  in  rheumatoid  arthritis  and  nodosity  of 
the  joints,  but  the  indications  for  its  employment  are  unknown.  The 
pains  of  this  troublesome  affection  are  sometimes  increased,  sometimes 
benefited,  by  heat,  some  cases  being  worse  in  summer,  others  in  winter; 
some  are  worse  during  the  day,  others  at  night.  All  these  forms  of  arse- 
nic will  sometimes  cure,  yet  its  action  is  capricious,  for  in  cases  apparently 
identical  it  sometimes  fails  and  sometimes  cures.  Its  effects  are  some- 
times astonishing,  for  stiffened  joints,  for  a  long  time  considerably  en- 
larged, become  reduced  to  their  natural  size,  and  regain  their  suppleness. 
Large  doses  are  necessary,  given  for  a  considerable  time,  and  it  must  bo 
borne  in  mind,  that  if  improvement  does  not  speedily  ensue  it  must  not 
be  concluded  that  the  medicine  will  fail.  Some  consider  it  necessary  to 
produce  the  toxic  effects  of  arsenic;  but  in  many  cases  improvement  cer- 
tainly results  without  pushing  the  remedy  to  this  extent. 

Dr.  Simpson  employed  arsenic  in  that  peculiar  affection  of  the  bowels 
prevalent  among  women,  characterized  by  the  copious  discharge  of  mem- 
branous shreds,  accompanied  by  much  emaciation,  and  a  long  train  of 
neuralgic  and  other  nervous  symptoms — an  affection  occasionally  co- 
existing with  dysmenorrhcea,  the  membranous  shreds  being  discharged 
both  from  the  bowels  and  uterus.  Like  other  metals,  arsenic,  though 
more  quickly  eliminated  than  some  metals,  as  lead,  is  retained  a  long 
time  in  the  body.  Some  maintain  that  arsenic  is  to  be  found  in  the 
bones  as  arseniate  of  lime,  a  statement  denied  by  others.  It  may  be  de- 
tected in  the  milk,  and  has  induced  serious  symptoms  in  suckling  infants. 

It  is  found  in  the  blood  chiefly  with  the  red  corpuscles.  It  is  sepa- 
rated from  the  body  by  the  urine,  the  stomach,  and  intestines,  and  per- 
haps by  the  liver.     After  arsenical  j)oisoning,  the  metal  is  found  in  the 


232  PHOSPHORUS. 

liver  in  quantities  larger  than  elsewhere.  It  may  he  that,  like  many 
other  metals,  it  is  separated  from  the  body  with  tlie  bile. 

We  know  nothing  of  its  influence  on  the  composition  of  the  urine. 
Some  experimenters  assert  that  the  urea  is  lessened,  and,  as  the  carbonic 
acid  separated  by  the  lungs  is  diminished,  they  conclude  that  arsenic 
diminishes  tissue  metamorphosis  to  a  considerable  extent.  Vogel  ob- 
served hajmato-globulin  in  the  urine  of  an  individual  poisoned  with  ar- 
seniuretted  hydrogen. 

Dr.  Garrod  states  that  arsenic  acid  is  less  irritating  to  the  stomach 
than  arsenious  acid.  Arseniates,  we  liave  seen,  are  much  less  poisonous 
than  arsenites.  The  additional  oxygen  appears  to  saturate  the  molecule 
of  arsenic  more  completely,  and  so  lessen  its  effects  on  the  tissues. 

Home  persons  are  highly  intolerant  of  arsenic,  so  that  even  one  minim 
of  liquor  arsenicalis  will  produce  violent  action  on  the  stomach  and  in- 
testines.    (Schiifer,  Bohm.) 


PHOSPHORUS. 


In  large  doses  it  is  an  irritant  poison,  but  the  symptoms  are  sometimes 
delayed  for  hours,  or  even  days,  and  they  occur  early  if  the  drug  is  given 
in  solution  as  in  ether,  slower  when  given  in  the  solid  form.  The  patient 
complains  of  burning  in  the  throat,  with  intense  thirst  and  severe  burning 
pain  in  the  stomach,  followed  by  distention  of  the  abdomen  and  vomiting 
of  a  dark  green  or  black  substance  with  the  odor  of  garlic,  and  sometimes 
phosphorescent.  There  are  the  usual  symptoms  of  collapse.  In  less 
Severe  cases,  vomiting  ceases  on  the  second  or  third  day,  but  on  the  oc- 
currence of  jaundice,  which  often  happens,  the  sickness  returns,  and  the 
rejected  matter  contains  dark-colored  blood.  There  is  now  pain  and  ten- 
derness over  the  liver,  generally  diarrhaa,  and  later  the  stools  become 
clay-colored.  At  first,  it  is  said,  there  may  be  fever,  the  temperature 
rising  even  to  102°,  but  subsequently  the  temperature  sinks  below  the 
standard,  and  in  one  case  it  fell  to  89°  Fall,  in  the  rectum.  Jaundice 
sets  in  from  the  second  to  the  fifth  day,  and  at  first  the  liver  is  apparently 
enlarged,  but  afterwards  its  size  diminishes  considerably.  Jaundice  may 
be  absent  even  with  advanced  fatty  degeneration  of  the  liver.  The  urine 
is  generally  scanty,  albuminous,  and  sometimes  bloody.  It  deposits  epi- 
thelium cells,  and  when  there  is  jaundice  it  contains  biliary  acid  and 
coloring  matter  with  leucine,  t}Tosine,  and  para-lactic  acid.  Urea  dis- 
appears almost  entirely  towards  the  termination  of  a  fatal  case.  Haemor- 
rhage and  purpura  often  occur.  Wounds  bleed  inordinately  and  some- 
times uncontrollably.  Later,  either  delirium  sets  in,  or  coma,  which 
may  terminate  in  convulsions.  The  post-mortem  reveals  most  of  the 
tissues  in  a  state  of  advanced  fatty  degeneration.  In  the  stomach  and  in- 
testines, there  is  general  inflammation  of  the  glandular  structures;  hence 
the  mucous  membrane  is  thickened  and  whitish.  The  epithelium  is 
granular  or  fatty  and  much  degenerated,  or  even  broken  iip.  The  liver 
is  either  enlarged,  with  its  cells  in  a  state  of  advanced  fatty  degeneration, 
or  is  contracted  from  destruction  of  the  cells.  The  kidneys  are  similarly 
affected,  the  epithelium  being  swollen,  granular,  fatty,  or  broken  up. 
The  heart,  the  voluntary  muscles,  and  other  structures  are  also  impli- 
cated. The  fatty  degeneration  affects  likewise  the  whole  of  the  arterial 
system,  down  to  the  microscopic  arterioles  (AVegner),  and  the  number  of 
the  blood  discs  are  said  to  be  lessened. 


PHOSPHORUS.  '2  S3 

Fatal  doses  of  phosphorus  lower  the  temperature  of  dogs  and  rabbits 
8°  to  12°  Fah. 

The  main  stress  of  the  poison  sometimes  falls  on  the  gastro-intestinal 
mucous  membraiie;  sometimes  on  the  nervous  system,  and  at  other  times 
on  the  blood  and  blood-vessels,  and  in  this  case  gives  rise  to  haemorrhages. 

The  duration  of  acute  poisoning  is  very  variable,  the  patient  may  die 
in  two  or  three  days,  but  generally  he  survives  from  one  to  three  weeks. 
Eecovery  is  slow. 

Jnrgensen  claims  to  have  saved  several  lives  by  direct  transfusion  of 
human  blood. 

The  effects  of  chronic  phosphorus  poisoning  have  lately  been  elabor- 
ately worked  out  on  animals  by  Dr.  George  Wegner,  with  most  singular 
results.  It  has  long  been  known  that  workmen  esposed  to  the  fumes  of 
phosphorus  are  liable  to  necrosis  of  the  jaw,  and  Dr.  ^Yegner  believes 
that  this  results  from  the  direct  action  of  the  phosphorus  on  denuded 
bone,  and  that  necrosis  will  not  set  in  unless  through  wounds  or  carious 
teeth  there  is  some  destruction  of  the  soft  tissues,  thus  enabling  the  plios- 
jihorus  to  reach  the  exposed  bone;  in  support  of  this  view  he  adduces  the 
following  reasons: — 1.  If  the  periosteum  of  an  animal  is  severely  wounded, 
and  phosphorus  is  given  in  the  form  of  a  pill,  even  for  months,  the  peri- 
osteal changes  do  not  take  place.  2.  When  the  tibia  of  a  raljbit  is  par- 
tially bared,  a  healthy  granulating  wound  is  soon  established,  but  under 
exposure  to  a  phosphorus  atmosphere,  periostitis  is  set  up  similar  to  that 
in  the  jaw.  3.  Many  workers  in  phospliorus  escape,  whilst  those  who  do 
suffer  have  carious  teeth. 

The  lower  jaw  is  more  often  affected,  but  the  upper  is  liable  to  attack; 
and  in  rare  cases  even  the  ])alate  and  frontal  bones. 

Dr.  Wegner  found  that  gradually  increasing  doses  of  phosphorus  or 
phosphorus  fumes  administered  to  rabbits  produced  congestion  of  the 
mucous  membrane  of  the  stomach,  this  membrane  becoming  of  a  lirown 
color  and  three  times  its  natural  thickness.  The  liver  is  chronically  in- 
flamed, with  great  increase  of  the  interstitial  tissue,  affecting  earliest  that 
portion  surrounding  the  acini.  This  new  tissue  contracts,  producing  atro- 
phy of  the  liver-cells,  and  obstruction  of  the  vessels  and  ducts.  The 
organ,  at  first  enlarged  and  livid  in  color,  sometimes  gradually  changes 
into  the  hob-nailed  liver,  or  into  a  shrunken  irregular  mass,  deformed  by 
contracting  bands. 

Given  in  doses  too  small  to  affect  the  stomach  and  liver,  phosphorus 
modifies  the  bones,  especially  in  growing  animals.  Thus,  where  spongy 
tissue  should  be  formed  in  the  growing  bone,  dense  solid  tissue  takes  its 
place,  which,  examined  by  the  naked  eye  and  microscope,  is  found  to 
consist  of  well-formed  bone,  and,  if  the  administration  -of  the  phospho- 
rus is  continued,  the  proportion  of  dense  bone  increases,  and  the  cancel- 
lous structure,  in  accordance  with  a  natural  process,  becomes  absorljed 
to  make  room  for  marrow  tissue,  till  at  last  no  cancellous  structure  is  left, 
and  afterwards  the  solid,  newly-formed  tissue  itself  also  undergoes  absorp- 
tion. Changes  occur  likewise  in  the  bony  substance  formed  by  the  perios- 
teum. The  new  bone  looks  natural,  but  the  microscope  reveals  that  it  is 
dense,  and  compact  masses  of  it  encroach  on  the  Haversian  canals,  pro- 
ducing in  them  at  last  a  general  narrowing  which  affects  even  bone 
formed  previous  to  the  admhiisti*ation  of  phosphorus.  If  phosphorus  is 
given  for  a  long  time  to  adult  animals,  the  spongy  tissue  thickens,  and 
the  compact  tissue  becomes  still  more  dense,  and  after  a  time  new  bony 


234 


PHOSPIIOKUS. 


tissue  is  deposited  on  the  inside  of  the  shaft,  incre.asinjy  till  the  Ijone 
actually  becomes  solid.  The  chemical  composition  of  the  bone  remains 
natural. 

Dr.  Wegner  found  also  that  under  the  influence  of  phosphorus,  callus 
after  fractures  or  resection  becomes  more  dense,  and  the  formation  of 
new  osseous  tissue  is  favored.  Kassowitz  has  very  successfully  treated 
5 CO  cases  of  rickets  with  phosphorus  in  doses  of  gV  gi".  dissolved  in  oil. 

The  changes  above  described  are  produced  by  ])hospliorus  as  such,  and 
not  after  its  conversion  into  phosphoric  acid.  For  phosphoric  acid  does 
not  produce  the  pe  :;uliar  changes  in  the  stomach  and  liver.  It  does,  how- 
ever, att'ect  the  bones  similarly,  in  very  large  quantities,  larger  than  could 
be  produced  by  the  phosphoric  acid  generated  from  phosphorus  intro- 
duced into  the  system;  Wegner  considers  that  it  acts  as  a  food,  pro- 
moting natural  growth. 

In  acute  poisoning,  phosphorus  itself  is  absorbed  unchanged,  for  in 
some  cases  the  breath,  the  urine,  and,  after  death,  the  tissues  themselves, 
are  luminous;  moreover,  it  has  been  chemically  detected  in  most  of  the 
tissues. 

The  jaundice  occurring  in  acute  phosphorus  j)oisoning  has  been  vari- 
ously explained.  Dr.  Ebstein  holds  that  it  is  not  due  to  destruction  of 
the  liver-cells,  but  to  catarrh  of  the  small  biliary  ducts,  causing  obstruc- 
tion and  leading  to  absorption  of  the  bile.  The  ductus  communis  chole- 
dicus  has  sometimes  been  found  occluded  by  a  tenacious  plug  of  mucus, 
thus  greatly  assisting  the  obstruction  of  the  smaller  ducts  in  the  produc- 
tion of  jaundice.  The  presence  of  biliary  acids  in  the  urine,  when  jaun- 
dice occurs,  certainly  supports  the  view  that  the  jaundice  depends  on 
absorption  from  obstruction  of  the  ducts,  rather  than  from  suppressed 
secretion  owing  to  the  destruction  of  the  liver-cells.  Sometimes  the  con- 
tents of  the  intestines  are  found  destitute  of  bile. 

According  to  Mr.  Ashburton  Thompson,  the  effects  of  repeated 
medicinal  doses  are  improved  appetite,  increased  rate  of  circulation, 
a  heightened  temperature,  perspiration,  irritation  of  the  skin,  abundant 
urine,  sometimes  loaded  with  deposit,  a  sharpening  of  the  mental  facul- 
ties, increase  of  muscular  power,  sensation  of  well-being,  sometimes  ner- 
vous excitement  shown  by  hesitation  and  trembling  (effects  more  readily 
induced  in  some  persons  than  in  others),  even  slight  clonic  convulsions, 
occasionally  some  venereal  ardor,  and,  less  frequently,  a  more  acute  tactile 
sensibility. 

Sometimes,  even  after  doses  now  considered  medicinal,  as  for  instance 
-sjygv.,  we  get  sickness  and  jaundice  which  may  last  weeks  or  months. 
The  drug  appears  to  affect  some  persons  much  more  readily  than  others, 
and  this  uncertain  action,  long  known,  used  to  be  ascribed  to  "idiosyn- 
crasy." It  has  been  asserted  that  phosphorus  in  medicinal  does  some- 
times causes  haematuria  and  albuminous  urine,  but  this  must  be  unusual, 
for  having  employed  phosphorus  in  a  very  large  number  of  cases,  I  have 
never  seen  this  result. 

Phosphorus  has  been  given  lately  in  neuralgia  with  consideable  suc- 
cess. It  appears  to  be  efficacious  in  neuralgia  of  any  part  of  the  body. 
Some  regard  phosphorus  as  well  nigh  a  specific.  As  might  be  expected, 
chronic  cases  take  longest  to  cure,  but  in  all  the  instances  susceptible  of 
benefit  relief  follows  the  first  few  doses.  Mr.  Thompson  employs  large 
doses,  giving  never  less  than  one-twentieth,  and  generally  one-twelfth,  of 
a  grain  every  three  hours.  Some  writers  think  one-hundredth  of  a  grain 
a  sufficient  dose. 


PHOSPHORUS.  235 

The  most  intractable  and  severe  cases  generally  occui',  as  Dr.  Anstie 
pointed  out.  in  the  degeneration  period  of  life;  but  even  in  these  in- 
stances phosphorus  may  prove  useful.  My  own  experience  hardly  Avar- 
rants  me  in  speaking  so  enthusiastically  of  this  drug  as  did  Mr.  Thomp- 
son. Yet,  though  it  not  uncommonly  fails  in  the  severe  forms  of  neuralgia 
of  middle  and  advanced  life,  still  it  must  be  considered  one  of  the  most 
valuable  remedies.  In  my  hands  it  has  yielded  less  satisfactory  results 
in  sciatica  than  in  many  other  forms  of  neuralgia.  Phosphorus  is  probably 
most  eflficacious  in  typical  neuralgia,  and  much  less  useful,  according  to 
my  experience,  in  those  imperfectly-developed  cases  where  the  neuralgia 
appears  to  be  allied  to,  or  passes  into,  sick  headache  of  pleurodynia,  and 
in  those  instances  of  nerve  pain  which  lack  many  of  the  more  distinctive 
characters  of  neuralgia.  Phosphorus  is  often  serviceable  in  angina  pec- 
toris, a  disease  closely  allied  to,  if  it  be  not  a  true,  neuralgia. 

Dr.  Richard  Hughes  recommends  phosphorus  in  chronic  inflammation 
of  the  rectum,  and  Dr.  Fleishmann,  of  Vienna,  approves  its  use  in  pneu- 
monia, especially  if  accompanied  by  typhoid  symptoms. 

Dr.  Bartholow  recommends  phosphorus  in  wakefulness  depending  on 
cerebral  anajmia  and  in  the  wakefulness  of  the  aged.  It  is  useful  in  the 
degenerative  changes  due  to  age,  and  under  its  use  I  have  seen  many 
cases  improve.  Cod-liver  oil,  too,  is  beneficial  in  the  same  cases  and 
should  be  given  simultaneously. 

Phosphorus  is  said  to  stimulate  the  sexual  functions,  and  patients 
have  told  me  that  they  were  constrained  to  discontinue  this  drug,  be- 
cause it  gave  them  trouble  in  this  way.  Old  men,  while  taking  phos- 
phorus, have  told  me  that  it  had  produced  a  return  of  sexual  capacity. 

Mr.  Thompson  held  that  phosphorus,  unless  given  in  large  and  un- 
safe doses,  is  neither  an  aphrodisiac  nor  useful  in  spermatorrhoea,  but 
that  in  small  tonic  doses,  -gV  to  ^V  gi'-j  it  will  remove  the  physical  and 
mental  debility  induced  by  spermatorrhoea.  A  large  dose,  Thompson 
taught,  acts  as  a  stimulant  to  the  brain,  and  fits  it  for  unusual  exertion, 
and  so  obviates  physical  and  mental  exhaustion  or  depression  from  over- 
work. * 

Phosphorus  is  certainly  useful  in  over-taxation  oi!  the  nervous  system 
by  too  arduous  or  too  anxious  work.  In  these  patients  brain  po\yer  is 
weakened,  the  mind  sooii  becomes  weary  and  fatigued;  they  are  irritable 
and  depressed,  and  sexual  capacity  in  many  instances  is  much  impau-ed. 
Here  a  prolonged  course  of  several  months  of  3V  to  ^^o  gi"'^"^  thrice  daily 
is  often  very  useful.     It  appears  to  promote  the  nutrition  of  the  nervous 

system.  .  i  •     i      i.    • 

Hammond  commends  phosphorus  in  cerebral  softening  and  m  hysteri- 
cal paralysis,  and  Anstie  in  chronic  alcoholism,  and  Thompson  recom- 
mends it  strongly  in  migraine. 

Phosphorus  is  recommended  in  melancholia.  Bartholow  highly  recom- 
mends it  in  acne  indurata. 

It  has  been  asserted  that  phosphorus  largely  increases  the  cpiantity  of 
urea  of  the  urine,  splitting  up,  it  is  said,  the  nitrogenous  tissues  and  con- 
verting them  into  fat  and  a  compound  which  ultimately  forms  urea; 
others  hold  that  the  fatty  degeneration  is  due  to  deficient  oxidation.  In 
men  the  products  of  nitrogenous  disintegration  appear  in  the  urine  as 
leucin  and  tyrosin.  Phosphorus  gives  to  the  urine  a  smell  of  violets  or 
of  sulphur.     (See  Turpentine.) 

Phosphide  of  zinc  1  gr.  to  h  gr.  doses,  has  been  strongly  recommended 


236  COLLODION. 

in  place  of  phosphorus.  In  compounding  phosphorus  it  must  not  be 
mixed  with  turpentine,  since  wit.li  this,  and  probably  with  other  essential 
oils,  it  combines  and  forms  an  inert  compound;  indeed,  turpentine  itself 
is  used  as  an  antidote  in  phosphorus  poisoning.  Eulenberg  and  Gutt- 
mann  point  out  that  with  a  solution  of  a  copper  salt  phosphorus  immedi- 
ately forms  a  phosphide  of  copper;  and  Bamberger's  experiments  lead 
him  to  conclude  that  copper  salts  are  far  more  efficient  antidotes  tlian 
turpentine.  The  sulphate  being  strongly  emetic  is  especially  useful. 
Three  to  five  grains  should  be  given  every  five  minutes  till  vomiting  en- 
sues.    (See  Turpentine.) 

Eed  allotropic  phosphorus  is  inert.  The  disagreeable  eructations  which 
occur  when  taking  phosphorus  are  due  to  the  oxidation  of  phosphorus, 
and  the  liberation  of  hydrogen,  the  nascent  gas  uniting  with  phosphorus 
to  form  phosphide  of  hydrogen. 


COLLODION. 


CoLLODiox  is  useful  in  many  ways.  It  is  used  to  adjust  accurately 
and  bind  together  the  edges  of  cuts  and  wounds,  and  to  exclude  air.  It 
is  sometimes  applied  to  chapped  hands  and  chapped  nipples;  but  for  these 
affections  there  are  better  applications,  as  glycerine  of  starch,  arnica 
cerate,  or  two  parts  of  eau  de  Cologne  to  one  of  glycerine.  For  chapped 
nipples,  often  so  difficult  to  heal,  equal  parts  of  sulphurous  acid  and  glyc- 
erine is  a  useful  comljination. 

Collodion,  painted  over  "suj^erficial  erysipelas,  slight  burns,  or  patches 
of  herpes  before  vesicles  are  developed,  subdues  inflammation,  eases  pain, 
and  checks  vesication.  L'nfortunately  the  collodion  coating  often  cracks, 
admits  air,  and  ceases  to  be  efficacious;  hence  collodion  is  inferior  to  a 
solution  of  nitrate  of  silver  in  water  or  nitrous  ether.  ( Vide  Xitrate  of 
Silver.) 

Dr.  Hare,  we  believe,  first  employed  collodion  for  boils.  There  are 
many  kinds  of  boils.  The  common  form  begins  as  a  pimple  or  pustule, 
whence  the  inflammation  spreads,  producing  a  hard,  painful  swelling,  the 
centre  of  which  dying  forms  a  core.  Xow  if  collodion  is  applied  at  the 
papular  or  pustular  stage,  the  swelling  around  the  pustule  suljsides,  and 
the  further  development  of  the  boil  is  arrested  in  the  pustular  stage,  col- 
lodion appearing  to  he  useless  if  the  pustule  has  burst.  The  matter  must 
not  be  let  out  after  the  collodion  application,  or  inflammation  recommen- 
ces, and  the  boil  follows  the  usual  course.  It  is  desirable  to  apply  fresh 
coatings  of  collodion  over  the  old  ones,  allowing  them  to  remain  till  the 
pustule  has  dried  up,  and  the  sore  has  healed.  If  much  pus  accumu- 
lates beneath  this  covering,  causing  considerable  pain,  the  collodion  should 
be  incised  under  carbolic  acid  and  the  pus  allowed  to  escape,  the  subsequent 
treatment  being  conducted  on  Lister's  carbolic-acid  plan.  This  treat- 
ment allays  the  great  irritation  often  accompanying  the  early  stages  of 
boils.  Dr.  Hare  prefers  the  contractile  collodion,  attributing  its  success 
mainly  to  the  pressure  it  exerts.  I  have  succeeded  with  flexible  collo- 
dion,  but   perhaps   the   contractile  would   have   answered   still  better.' 

'  The  extension  of  a  carbuncle,  may  sometimes  be  limited  by  ti£rhtly  strapping  vrith 
strips  of  adhesive  plaster,  appUed  concentrically  from  the  borcler  inward,  aromid  and 


OILS.  237 

Some  doctors  add  a  drachm  of  spirit  of  turpentine  to  each  ounce  of  collo- 
dion. 

Collodion  solutions  of  gutta-percha,  or  india-rubber  in  chloroform, 
prevent  the  pitting  of  small-pox,  and  the  flexible  variety  of  collodion  is 
better  for  this  purpose. 

A  mixture  of  collodion  and  carbolic  acid  is  useful  in  toothache  due 
to  an  exposed  ai^  inflamed  pulp.  A  jelly  is  made  by  melting  in  a  test- 
tube  some  crystamzed  carbolic  acid,  then  adding  an  equal  quantity  of  col- 
lodion. A  portion  of  this  preparation  on  a  small  piece  of  cotton-wool  is 
inserted  into  the  hollow  painful  tooth,  with  sometimes  aggravation  of 
the  pain,  but  in  a  few  seconds  it  begins  to  diminish  and  soon  ceases. 

Contractile  collodion,  with  which  some  mix  iodine,  painted  over  the 
inflamed  part  in  acute  gout,  will  speedily  relieve  the  pain,  although  for 
a  brief  space  the  application  increases  it.  Too  many  coats  must  not  be 
applied,  or  the  contraction  is  too  great  and  dragging  on  the  skin,  excit- 
ing a  good  deal  of  pain,  or  even  producing  vesication. 

Sir  I).  Corrigan  treats  the  incontinence  of  children  with  collodion. 
The  prepuce  is  drawn  forward  by  the  left  hand,  and  the  little  cap  thus 
formed  at  its  extremity  is  smeared  over  with  collodion,  which  contract- 
ing, draws  closely  together  the  edges  of  the  prepuce,  and  effectually  pre- 
vents the  exit  of  urine.  A  fortnight  of  this  plan,  which  gives  no  pain 
and  does  not  prevent  sleep,  sometimes  suffices  for  the  cure.  When  it  is 
needful  to  pass  water,  the  little  cap  of  collodion  can  be  easily  chipped  off 
with  the  nail.  The  prepuce  in  the  morning  is  found  distended  with 
urine.  Sir  D.  Corrigan  thinks  that  it  would  answer  as  well  to  paint  the 
collodion  over  the  orifice  of  the  urethra.  This  plan  I  find  unsuitable  for 
girls,  as  it  excites  smarting,  and  induces  them  to  pick  off  the  collodion. 

Two  parts  of  glycerine  to  a  hundred  parts  of  collodion  sets  without 
contracting  or  dragging  the  skin. 


COD-LIVER  OIL.  DUGONG  OIL. 

ALMOND   OIL.  PALM   OIL. 

POPPY   OIL.  LAED. 

HExMP-SEED   OIL.  SUET. 

LINSEED   OIL.  WAX. 

COCOA-NUT   OIL.  Etc. 

Fats,  in  one  form  or  other,  are  found  abundantly  in  both  the  animal 
and  vegetable  kingdoms,  showing  their  great  importance  in  organic  life. 

Fats  are  necessary  foods  to  the  animal  body,  being  heat-giving,  force- 
supplying,  and  plastic.  Their  combustion  contributes  mainly  to  the  gen- 
eration of  the  heat  of  the  body.  They  are  essential  to  tissue  formation, 
for  without  them  nutrition  and  growth  would  be  very  imperfect,  if  not 
impossible. 

Their  combustion,  moreover,  supplies  most  of  the  force  appropriated 

over  the  swelling.  I)r.  Planat  highly  recommends  the  application  of  arnica  ointment 
(one  part  of  extract  of  fresh  arnica  flowers  to  two  of  honey)  spread  on  diachylon  plaster 
and  placed  over  the  boil,  the  application  being  renewed  once  or  twice  a  day.  He  finds 
the  internal  use  of  arnica  benelicial. 


238  OILS. 

by  the  nitrogenous  structures,  and  through  them  to  be  converted  into 
muscular  force,  secretive  force,  nerve  force,  etc. 

For  the  most  part,  all  fats,  so  far  as  we  know,  have  the  same  physi- 
cal properties,  differing  only  in  the  melting  point.  In  their  chemical 
nature,  however,  they  differ  much,  but  after  entering  the  blood  they  are 
probably  converted  into  a  fat  of  uniform  composition. 

Oils  and  fats  are  iised  to  lubricate  and  to  supple  the  skin  Avhen  it  has 
lost  its  elasticity,  and  become  dry,  hard,  and  liable^o  crack;  for  in- 
stance, in  many  scaly  diseases,  as  psoriasis  and  xeroderma.  They  should 
be  employed  in  conjunction  with  warm  baths. 

Fats,  moreover,  are  applied  to  the  surface  of  the  body  to  prevent  irri- 
tation from  such  excreta  as  urine  or  fa?ces,  or  b}^  acrid  discharges,  as  in 
eczema,  and  when  used  for  this  protective  purpose,  some  stimulating  sub- 
stance, as  oxide  of  zinc,  is  generally  incorporated  with  them. 

Simple  oils  are  used  to  soften  and  facilitate  the  removal  of  scabs,  as 
of  impetigo,  eczema,  and  favus.  Poultices  are  likewise  useful  in  favus 
preparatory  to  epilation. 

Oils  are  sometimes,  with  occasional  success,  rubbed  in  to  the  skiu  of 
the  whole  surface,  to  prevent  the  debilitating  sweating  accompanying 
exhausting  disease,  as  phthisis;  but  this  process  is  inferior  to  that  of 
sponging  the  skin  with  a  Aveak  acid  Avash,  and  to  other  means.  AYith  the 
ancient  Komans,  during  the  decline,  when  warm  baths  Avere  so  much  in- 
dulged in,  it  was  the  custom  to  anoint  the  bod}^  Avith  fats,  to  check  the 
j^rofuse  SAveating  caused  by  this  enervating  habit. 

Fats  are  sometimes  rubbed  into  the  skin  Avith  a  vicAV  to  their  absorp- 
tion, so  as  to  minister  to  the  nutrition  of  the  body. 

Fats  and  oils  are  in  general  use  as  excipients  for  the  application  of 
various  agents  to  the  skin. 

It  has  been  asserted  that  the  inunction  of  the  bod}'  with  fatty  sub- 
stances Avill  induce  a  considerable  fall  in  its  temi^erature;  but  in  a  solitary 
testing  instance  I  found  this  statement  to  be  incorrect. 

Rubbing  the  hands  and  feet  with  some  firm  fat  will  remove  the  irk- 
some sensation  of  heat  and  tightness  produced  b}'  the  rashes  of  scarlet 
fever  or  measles. 

Some  practitioners  treat  scarlatina  solely  by  inunctions,  anointing 
thoroughly  the  skin  of  the  whole  body  tAvice  or  three  times  a  day  Avith  a 
bland  fat,  or  oil,  Avhich  is  not  to  be  Aviped  off  during  couA'alescence  from 
scarlatina.  Dr.  Budd,  of  Bristol,  recommends  the  inunction  of  oil;  the 
jiatient  takes  a  bath  at  night,  and  after  being  Aviped  quite  dry,  a  bland 
oil,  like  almond  oil,  is  rubbed  over  the  whole  body.  This  treatment  is 
said  to  assist  desquamation,  and  to  prevent  sequels:  moreover,  it  proba- 
bly lessens  the  risk  of  contagion  by  preventing  the  diffusion  of  the  branny 
particles  of  the  skin  by  currents  of  air. 

In  cases  of  ringAvorm  it  is  a  useful  practice  to  prevent  the  extension 
of  the  disease  by  greasing  the  head  very  freely  to  hinder  the  sporules 
reaching  the  unaffected  hair.  The  uncontaminated  members  of  the  fam- 
ily should  also  use  grease  to  the  hair  freely  for  the  same  purpose,  and 
probably  it  Avould  be  more  i:)reventive  to  use  a  mild  mercurial  pomade, 
or  quinine  dissolved  in  glycerine,  so  that  the  sporules  may  alight  on  some 
substance  destructiA^e  to  them. 

Oils  and  fats  are  not  used  topically  in  diseases  of  the  mouth,  nor  do 
fats  undergo  alteration  in  this  cavity,  and  they  are  almost  as  little  affected 
in  the  stomach.     If  enclosed  in  albuminous  walls,  as  in  the  form  of  cell. 


OILS. 


239 


these  being  dissolved,  the  fat  is  set  free.  Although  themselves  not  acted 
upon  by  the  stomach,  fats,  however,  act  npon  the  other  forms  of  food: 
they  certainly  promote  the  fermentation  of  sugar  and  starch;  and  it  is 
generally  accepted  that  fats,  by  assisting  those  chemical  changes  which  con- 
stitute digestion,  aid  the  conversion  of  the  nitrogenous  food.  For  exam- 
|3le,  fats  assist  the  fermentation  of  milk,  and  promote  the  process  of  arti- 
ficial digestion;  and  this  action  of  fats  upon  food  can  be  demonstrated 
outside  the  body.  But  how  fats  effect  these  changes,  and  whether  at  the 
same  time  they  themselves  are  in  any  measure  modified  in  constitution, 
are  questions  at  present  quite  unsettled.  The  importance  of  this  property 
of  fats  must  be  sufficiently  apparent,  and  needs  no  further  comment. 
In  large  quantities  they  hinder  digestion,  possibly  by  their  decomposition, 
and  the  formation  of  acids  foreign  to  the  stomach. 

Fats  are  mainly,  if  not  exclusively,  digested  and  absorbed  in  the  in- 
testine. The  pancreatic  ferment  steapsin  causes  some  of  the  fat  to  take 
up  a  molecule  of  water  and  produces  glycerine  and  fatty  acids.  Pancrea- 
tic secretion  also  emulsionizes  fats.  The  further  absorption  is  due  to  bile. 
Bile  also  emulsionizes  fats. 

It  has  been  surmised  that  fat  may  become  saponified,  and  so  pTiss 
through  the  walls  of  the  intestines  into  the  blood,  and  jirobably  a  small 
j)art  does  pass  into  the  circulation  in  this  form;  but,  as  much  unsaponi- 
fied  fat  is  visible  in  the  epithelium  cells  covering  the  villi,  and  much  can 
be  extracted  from  the  chyle,  the  chief  part  must  undergo  absorption  in 
another  manner. 

The  passage  of  fats  through  the  moist  animal  membranes  forming  the 
intestinal  canal,  is  probably  justly  ascribed  to  the  action  of  the  bile;  and 
in  support  of  this  proposition,  apart  from  other  evidence  possible  to 
adduce,  it  may  be  advanced  that — 

I.  In  capillary  tubes  moistened  with  water,  fats  rise  scarcely  at  all; 
but  if  the  tubes  are  moistened  with  bile  the  fats  rise  from  twelve  to  four- 
teen times  higher. 

II.  While  fats  pass  with  extreme  difficulty  through  moist  animal  mem- 
branes, if  these  are  moistened  with  bile  the  fats,  as  may  be  shown  experi- 
mentally, pass  readily. 

Fats  pass,  to  a  small  extent,  into  the  blood  by  the  agency  of  the  intes- 
tinal juice. 

The  chief  part  of  the  fat  passes  into  the  lacteals;  a  little  into  the 
veins,  to  be  conveyed  to  the  liver,  there  to  be  converted  into  cholic  acid; 
or,  at  least,  it  is  probable  that  the  oleic  acid  undergoes  this  change.  The 
cholic  acid,  uniting  with  the  soda  set  free  when  the  hydrochloric  acid  of 
the  gastric  juice  is  poured  into  the  intestines,  forms  a  kind  of  soap, 
namely,  the  taurocholate  and  glycocholate  of  soda.  These  again  find 
their  way  into  the  intestines,  and  after  serving  their  destined  purpose 
there,  the  base  reunites  with  the  acid  of  the  gastric  juice  from  which  it 
has  been  separated. 

The  influence  of  fats  on  the  secretion  of  bile  varies  according  to  cir- 
cumstances; if  taken  on  an  empty  stomach,  fats  lessen  the  biliary  secre- 
tion; if  taken  with,  or  after  food,  they  increase  it. 

As  food  greatly  augments  the  flow  of  bile,  we  have  here  an  indication, 
abundantly  corroborated  by  experience,  to  give  fats  either  with  or  soon 
after  a  meal. 

The  melting  point  of  a  fat  must  mfluence  its  absorption;   for  if  this 


240  OILS. 

point  is  above  the  temperature  of  tlie  body,  the  fat,  unless  dissolved  in  the 
more  liquetiable  fats,  must  remain  unabsorbed. 

The  stomach  tolerates  animal  far  better  than  vegetable  fats:  moreover, 
animal  fats  may  be  given  in  larger  doses,  and  for  a  longer  time;  circum- 
stances which,  in  some  measure,  explain  the  medicinal  superiority  of 
animal  over  vegetable  fats. 

There  is  a  limit  to  the  quantity  of  fats  absorbable  by  the  body.  In 
regard  to  cod-liver  oil,  at  first  only  a  small  quantity  is  taken  up,  and 
often  for  some  weeks  some  of  it  appears  in  the  motions:  however,  more 
and  more  of  it  becomes  absorbed,  till  full  doses  are  borne,  and  find 
entrance  into  the  circulation;  but  in  too  large  a  quantity  this  oil  is  liable 
to  decompose,  and  to  form  hurtful  acids,  exciting  nausea,  vomiting,  colic, 
and  diarrhoea.  This  limitation  to  the  quantity  absorbed  as  well  as  the  ir- 
ritation caused  by  an  excess  remaining  in  the  intestines,  are  sufficient 
reasons,  to  say  nothing  of  economy,  to  make  it  undesirable  to  give  more 
fat  than  can  be  appropriated.  Too  large  a  dose  is  both  wasteful  and 
harmful.  By  examining  the  motions  day  by  day  we  can  at  any  time 
ascertain  if  too  much  is  administered. 

Catarrh  of  the  intestines  is  a  condition  unfavorable  to  the  absorption 
of  fat.  Oils  are  sometimes  given  after  a  poisonous  dose  of  a  corrosive 
substance,* with  the  intention  of  forming  a  protective  sheathing  to  the 
mucous  membrane,  but  it  is  impossible  to  give  a  coating  of  oil  to  a  mem- 
brane moistened  with  water.  Cod-liver  oil  sometimes  overcomes  obstinate 
habitual  constipation  in  children.  Figs  kept  in  Lucca  oil,  and  one  or  two 
eaten  daily,  are  gently  relaxing. 

Fat  is  speedily  saponified  in  the  lacteals  and  blood-vessels,  and  most  of 
it  in  the  blood-vessels  appears  to  collect  in  the  blood-corpuscles,  and  may 
contribute  to  their  formation,  growth,  etc. 

Fats,  as  we  have  said,  are  heat-giving,  force-supplying,  and  plastic. 
In  common  with  other  combustible  substances,  they,  through  oxidation, 
u])hold  the  temperature  of  the  body.  This,  though  an  important,  is  not 
their  only,  nor  their  most  valuable,  function. 

Fats,  like  phosphate  of  lime,  are  necessary  both  to  growth  and  nutri- 
tion; for  in  the  most  vitally-endowed  organs  fats  are  found  in  excess,  and 
abound  wherever  cell -growth  proceeds  rapidly;  it  abounds  even  in  disease, 
for  much  fat  is  found  in  fast-growing  cancer;  it  is  found,  moreover,  asso- 
ciated with  the  more  highly-organized  constituents.  Thus  the  fat  existing 
in  pus  is  chiefly  associated  wdth  the  corpuscles,  comparatively  little  being 
found  in  the  serum.  More  fat  is  found  in  plastic  than  in  non-plastic 
formations:  in  fact  observations  day  by  day  demonstrate  more  and  more 
the  importance  of  fats  as  tissue-forming  substances.  Facts  like  these  ob- 
viously bear  on  the  use  of  the  members  of  this  group  in  disease;  but  to 
this  subject  Ave  shall  return  shortly. 

Observations  tend  to  show  that  fats  are  force-yielding  substances,  and 
that  tlie  peculiar  forces  of  the  body  are  mainly  derived  from  the  fats  we 
consume.  Only  a  short  time  ago  it  was  considered  that  the  forces  of  tlie 
body  were  derived  from  the  combustion  of  the  nitrogenous  structures,  but 
many  circumstances  tell  conclusively  against  this  hypothesis. 

1.  After  severe  and  prolonged  exercise,  the  urea  of  the  urine  is  scarcely  increased; 
and  as  this  substance  is  a  measure  of  the  consunijition  of  nitrogenous  materials,  it  fol- 
lows that  at  such  times  but  little  of  it  is  consumed. 

2.  Under  exertion,  enormous  quantities  of  carbonic  acid  are  exhaled  from  the  lungs, 
pointing  indubitably  to  the  combustion  of  carbo-hydrates,  or  of  fatty  substances,  the 
urea  at  the  same  time  not  being  increased. 


OILS.  241 

3.  The  combustion  occurs  chiefly,  not  in  the  blood,  but  in  the  muscles  themselves, 
for  when  these  are  separated  from  the  body,  and  made  to  coniract  under  a  bell-glass, 
they  are  found  to  yield,  during  the  time  of  their  activity,  an  enormous  quantity  of  car- 
bonic acid. 

4.  It  has  been  found  by  experiment  that  when  only  starchy  and  fatty  foods  are 
eaten,  great  exertion  and  prolonged  labor  can  be  endured,  while  at  the  same  time  the 
urea  of  the  urine  is  but  little  increased. 

Drs.  Cutler  and  Bradford,  using  Malassez's  method  of  connting  the 
red  eorpnscles,  find  tliat  in  health  cod-liver  oil  causes  an  increase  in  the 
number  of  red  corpuscles,  and  a  slight  increase  in  the  white. 

Dr.  John  Day's  (of  Geelong)  higenious  experiments  show  that  fats 
possess  considerable  power  in  converting  oxygen  into  peroxide  of  hydro- 
gen; also  that  the  coloring  matter  of  the  blood  rapidly  decomposes  this 
into  water  and  nascent  oxygen  with  its  characteristic  active  properties; 
and  he  suggests  that  fats  may  play  this  important  part  in  the  blood, 
making  inert  oxygen  of  the  atmosphere  into  active  oxygen.  His  experi- 
ments show  that  the  iron  of  the  coloring  matter  of  the  blood  is  probably 
the  agent  decomposing  the  peroxide  of  hydrogen.  Ether  also  possesses 
great  power  to  form  oxygen  into  peroxide  of  hydrogen;  and  Dr.  Day 
suggests  that  the  efficacy  of  etherized  cod-liver. oil  may  be  due  to  the  large 
quantity  of  peroxide  of  hydrogen  it  contains. 

Fats  being  necessary  to  growth,  nutrition,  and  the  due  performance  of 
the  bodily  functions,  are  peculiarly  suited  to  convalescents  from  acute 
general  diseases.  Fats  are  also  useful  in  many  chronic  affections.  On 
the  subsidence  of  many  acute  inflammations,  as  of  the  kidneys,  heart,  or 
lungs,  a  chronic,  but  not  less  fatal,  condition  may  be  left,  a  condition  the 
danger  of  which  is  in  proportion  to  the  health  of  the  patient  previous  to 
the  acute  attack.  If  the  patient's  health  has  been  impoverished,  or  if  he 
is  the  subject  of  tuberculosis,  or  of  scrofula,  many  sequela?  are  apt  to 
occur.  Middle-aged  and  old  people,  in  whom  the  nutritive  process 
begins  to  flag,  are  more  liable  to  chronic  diseases  after  acute  attack.  A 
like  danger  threatens  cliildren  whose  previous  health  has  been  damaged 
by  unhygienic  conditions.  It  benefits  the  chronic  degenerative  diseases 
of  old  age.  These  and  other  maladies  depend  on  deficient  nutrition,  and, 
as  fats  are  peculiarly  promoters  of  this  function,  they  are  especially  useful 
in  such  chronic  maladies. 

The  dependence  of  chronic  affections  on  the  state  of  general  nutrition 
may  be  shown  in  another  way.  Persons  are  found  to  suffer  from  some 
slight  local  affection,  but  little  troublesome  while  the  health  is  unbroken, 
but  as  the  weakest  link  of  the  chain  is  the  first  to  yield,  so  if  the  health 
gives  way,  the  local  mischief  becomes  immediately  developed  or  aggravated. 
Thus  many  individuals  are  able  to  measure  the  state  of  their  general 
health  by  the  conditions  of  a  local  disease.  Here,  again,  any  treatment 
restorative  of  the  general  health  will  reduce  the  local  affection  to  its 
former  unimportant  state,  and  in  such  a  case  cod-liver  oil  is  often  indi- 
cated. 

Thus  experience  confirms  the  efficacy  of  cod-liver  oil  in  many  chronic 
inflammations,  as  of  the  heart,  lungs,  and  kidneys,  and  in  the  sequelse  of 
the  acute  specific  diseases,  as  the  chronic  discharge  from  the  ears  or  nose 
so  often  left  by  scarlet  fever  or  measles. 

Cod-liver  oil  is  of  special  service  in  scrofula,  tending  to  remove  the 
various  manifestations  of  this  disease,  as  chronic  discharges  from  the  ears 
and  nose,  strumous  ophthalmia,  strumous  disease  of  the  bones,  strumous 
abscesses,  etc. 

16 


242  OILS. 

In  the  treatment  of  phthisis  cod-liver  oil  stands  pre-eminent.  The 
term  phthisis,  however,  includes  sevei-al  distinct  diseases.  For  our  purpose 
it  is  sufficient  here  to  divide  them  into  the  febrile  and  non-febrile  varieties: 
— those  forms  manifesting  preternatural  heat  of  the  body,  and  those  in 
which  the  temperature  is  natural,  or  rises  only  occasionally,  and  for  a 
short  time.  The  existence  of  fever  in  the  febrile  forms  of  phthisis  is  by 
no  means  an  indication  of  the  uselessness  or  harmfulness  of  cod-liver  oil, 
for  in  this  condition  many  patients  derive  considerable  benefit  from  it.  In 
this  form  of  phthisis,  as,  indeed,  in  all  cases,  we  must  Ije  guided,  in  the 
emplovment  of  this  remedy,  not  only  by  the  nature  of  the  disease,  but 
also  by  the  state  of  the  patient  in  other  respects.  If  the  digestion  is 
good,  cod-liver  oil  may  generally  be  given  with  advantage,  but  if  the 
stomach  is  irritable,  then  cod-liver  oil  does  harm  by  still  further  dis- 
ordering it. 

In  the  chronic,  or  non-febrile  forms  of  phthisis,  cod-liver  oil  is  gener- 
ally well  borne,  and  does  great  good;  but,  as  with  the  more  acute  varieties, 
it  sometimes  upsets  the  stomach.  It  is  generally  held  that  diarrhcjea  in 
.  phthisis  is  a  decisive  indication  against  the  employment  of  the  oil ;  but 
this  is  only  partly  true.  Cod-liver  oil,  no  doubt,  sometimes  increases 
diarrha^a,  but  this  chiefly  arises  when  the  dose  is  unduly  large,  or  too 
frequently  administered;  if  only  a  teaspoonful  is  given  at  a  dose  once  or 
twice  a  day,  the  oil  often  even  controls  diarrhoea.  In  cases  of  phthisis 
with  diarrhoea,  it  is  'a  good  plan  to  begin  the  cod-liver  oil  with  cautiously 
small  doses,  and  if  it  suits  it  may  be  given  with  greater  freedom.  An  ex- 
cellent method  is  to  give  a  teaspoonful  the  last  thing  at  night,  immediately 
before  sleep,  when  it  may  often  be  borne  without  producing  either  nausea 
or  diarrhoea,  though  previously  it  had  occasioned  one  or  both  of  these 
symptoms. 

In  the  early  stage,  as  might  be  expected,  j^hthisis  is  most  benefited  by 
the  use  of  oils. 

Phlegmatic  persons  with  sallow  skins  and  dark  complexions,  benefit 
more,  it  is  siiid,  by  cod-liver  oil  than  persons  of  sanguine  temperament 
and  florid  complexion. 

Cod-liver  oil  is  often  very  serviceal)le  in  chronic  rheumatism,  rheu- 
matoid arthritis,  chronic  gout,  chronic  skin  affections,  syjihilitic  or  other- 
wise. It  is  also  particularly  useful  in  emphysema  of  the  lungs,  and 
chronic  bronchitis;  in  the  former  checking  lung  degeneration,  in  the 
latter  controlling  the  expectoration. 

Many  persons,  especially  the  aged,  complain  of  much  sinking,  or  a 
sensation  of  "craving"  at  the  epigastrium,  relieved  for  a  short  time  only 
by  food,  a  condition  sometimes  connected  with  atonic  dyspepsia,  some- 
times dependent  on  the  general  state  of  health.  If  the  intestinal  canal 
is  not  in  an  irritable  condition,  cod-liver  oil  will  remedy  this  sinking. 
Middle-aged  patients  suffering  from  that  anomalous  group  of  symptoms 
called  hysteria,  sometimes  complain  of  the  same  irksome  symptoms.  In 
this  case  oil  will  remove  the  sinking,  while  it  often  simultaneously  relieves 
the  other  symptoms  of  the  group. 

Cod-liver  oil  and  quinine  is  the  best  treatment  for  giddiness  in  the 
aged,  that  is,  when  this  symptom  is  not  ascriljable  to  serious  organic  brain 
disease,  but  probably  to  atheromatous  changes  in  the  brain-vessels,  or  to 
a  weak  heart.  Indeed  cod  liver  oil,  since  it  promotes  nutrition,  is  highly 
useful  in  the  suffering  due  to  old  age. 

Fats  are  of  special  use  in  the  chronic  diseases  of  children,  arising  from 


OILS.  243 

mal-]iutrition,  and  Jiny  local  malady  will  generally  disappear  on  restoring 
nutrition  and  growth  to  the  healthy  state. 

Cod-liver  oil  often  favorably  modifies  the  course  of  laryngismus  stridu- 
lus, rickets,  chorea,  the  middle  and  after  stage  of  whooping-cough,  and 
chronic  coughs. 

The  obstinate  constipation  of  children  sometimes  yields  to  cod-liver 
oil. 

The  chronic  diarrhoea  of  a  few  pale,  stinking,  pulpy  motions  daily  will 
reduce  a  child  a  few  months  old  almost  to  a  skeleton.  The  skin  becomes 
leathery  and  wrinkled,  food  is,  perhaps,  rejected,  and,  when  brought  to 
this  dangerous  pass,  thrush  breaks  out.  While  combating  the  diarrhoea 
or  vomiting,  a  teaspoonful  or  half  a  teaspoonful  of  cod-liver  oil,  given  to 
the  child  nightly  before  sleep,  gradually  increasing  the  quantity  and  fre- 
quency of  the  dose,  will  neither  increase  the  vomiting  nor  the  diarrhoea, 
but,  on  the  contrary,  will  promote  nourishment,  growth,  improve  the 
general  health,  and  rescue  the  patient  from  a  perilous  condition. 

Hitherto,  fats  have  been  spoken  of,  for  the  most  part,  in  common,  but 
they  certainly  are  not  all  equally  useful  therapeutic  agents. 

As  we  have  seen,  animal  fats  are  to  be  preferred  to  vegetable  fats;  and 
liver  fats  are  generally  esteemed  beyond  all  others.  Whether  cod-liver 
oil  is  superior  to  that  derived  from  the  livers  of  other  animals  is  difficult 
to  decide — since  much  of  the  cod-liver  oil  of  commerce  is  procured,  not 
only  from  the  livers  of  various  fish,  but  likewise,  it  is  said,  from  those 
of  other  marine  animals. 

The  superiority  of  cod-liver  oil  has  been  thought  to  depend  on  the 
minute  quantities  of  iodine,  phosphorus,  or  bile  it  contains — a  conjecture 
clearly  wrong,  for  the  effect  of  these  substances  in  disease  is  dissimilar  to 
that  of  the  oil. 

The  su])eriority  of  liver  oils  is  ascribable  to  their  easy  toleration  by  the 
stomach.  They  generally  can  be  taken  without  inconvenience  for  months 
or  years,  while  other  fats  and  oils  often  produce  nausea,  loss  of  appetite, 
and  diarrhoea.  There  is  reason  to  think  that  cod-liver  oil  is  more  easily 
absorbed  than  other  oils. 

Cod-liver  oil,  at  first,  often  excites  nausea,  vomiting,  and  disagreeable 
eructations.  Occasionally,  the  difficulty  in  overcoming  the  distaste  for 
this  medicine  is  almost  insuperable;  yet  disgust  is  generally  overcome,  and 
in  a  short  time  the  oil  is  taken  even  with  relish,  and  children,  indeed, 
often  come  to  regard  it  as  a  treat.  Sometimes  at  the  commencement  of 
the  course,  a  child  becomes  languid,  appetiteless,  and  appears  worse; 
but  usually,  after  a  week  or  ten  days,  the  oil  begins  to  be  tolerated,  and 
then  improvement  sets  in. 

The  nausea  and  vomiting  sometimes  caused  by  this  remedy  may  be 
produced  by  too  large  a  dose.  At  first  a  teaspoonful  only,  or  even  less, 
is  enough;  and  should  the  stomach  manifest  intolerance,  one  dose  only 
should  be  given  daily;  and  it  is  a  good  practice  to  give  it  at  night-time, 
just  before  lying  down  to  sleep. 

Cod-liver  oil  is  often  administered  in  such  quantities  that  it  can  scarcely 
be  borne,  even  Avhen  the  stomach  is  accustomed  to  it.  Weeks,  and  even 
months  may  elapse,  before  full  doses  of  oil  can  be  digested  and  absorbed; 
hence,  if  swallowed  in  iindue  bulk,  it  merely  passes  off  by  the  motions, 
and  by  its  decomposition  is  liable  to  disorder  the  intestines.  An  examina- 
tion of  the  motions  will  show  whether  the  oil  is  given  in  excess. 

Cod-liver  oil  should  be  taken  after  food,  on  orange,  or  ginger-wine  or 


244  OILS. 

weak  brand^'-and- water,  or  some  agreeable  tincture  of  orange-peel,  and 
should  be  so  poured  as  not  to  touch  the  glass,  but  to  float  on  the  surface 
of  the  wine  or  the  brandy  as  a  srlobule,  and  thus  tossed  off.  A  little  salt 
taken  immediately  before  and  after  the  dose  often  removes  the  taste,  and 
prevents  nausea,  and  it  is  said  that  a  few  drops  of  ketchup  added  to  the 
oil  will  cover  its  taste. 

A  mixture  composed  of  equal  parts  of  cod-liver  oil  and  fresh  mucilage 
of  gum  acacia  and  water,  has  very  little  taste,  and  the  addition  of  two 
minims  of  oil  of  lemons  to  each  ounce  of  this  mixture  effectually  conceals 
the  fishy  flavor. 

A  cod-liver  oil  jelly  has  recently  been  prepared,  which  is  said  to  contain 
70  per  cent,  of  oil.     Bolted  like  jelly  it  is  almost  tasteless. 

Xotwithstanding  such  ingenious  devices,  it  is  not  uncommon  to  meet 
with  patients  who,  even  after  repeated  trials,  cannot  tolerate  the  oil  on 
account  of  the  eructations,  loss  of  appetite,  nausea,  or  vomiting.  In  some 
cases  this  intolerance  is  due  to  dyspepsia,  but  it  is  generally  due  to  that 
inability  to  digest  and  absorb  fats  so  commonly  noticed  in  consumption, 
even  before  its  development.  This  fact  has  been  much  dwelt  on  by  Dr. 
Balthazar  Foster,  who,  led  by  some  suggestive  experiments  of  Claude 
Bernard — in  the  case  of  patients  intolerant  of  oil,  uses  ether  as  a  means  of 
assisting  the  digestion  and  absorption  of  fat. 

Claude  Bernard  has  shown  that  the  action  of  ether  "is  twofold — 
(1)  it  stimulates  the  pancreas  and  glands  of  the  duodenum  to  pour  out 
their  secretions  freeh-,  and  (2)  at  the  same  time  facilitates  the  absorption 
of  those  very  substances  which  these  secretions  are  designed  to  digest.  In 
other  words,  ether  not  only  obtains  for  us  the  secretions  required  to  digest, 
but  promotes  the  absorption  of  these  fats  when  digested."  Bernard 
maintains  that  fats  are  chiefly  absorbed  by  means  of  these  secretions. 
After  a  prolonged  investigation  of  the  influence  of  ether.  Dr.  Balthazar 
Foster  finds  that  oils  and  fats,  which  otherwise  cause  nausea  and  sick- 
ness, are,  by  means  of  this  combination,  letained  and  digested,  thurs  in- 
creasing appetite,  nutrition,  and  weight.  Dr.  Foster  employs  ether  purus 
of  the  Pharmacopffiia  in  doses  of  from  ten  to  fifteen  minims  to  every  two 
drachms  of  oil.  The  ether  may  be  given  either  separately,  or  with  the 
oil;  but  as  the  ether  masks  the  unsavoriness  of  the  oil,  it  is  better  to 
combine  them. 

I,ime-water  mixed  with  the  oil  sometimes  obviates  nausea,  and  even 
the  diarrhoea  induced  by  the  ingestion  of  cod-liver  oil. 

Fats  are  consumed  in  the  body,  but  sometimes  a  small  quantity  es- 
capes Avitli  the  fasces  and  urine.  The  quantity  escaping  by  the  urine  is 
insignificant,  except  in  the  disease  called  chylous  urine,  in  wliicii  fat  is 
often  present  in  considerable  amount.  In  Bright's  disease,  a  little  fat 
is  voided  with  the  uriniferous  casts  in  the  urine. 


CASTOR   OIL.     CROTOX   OIL. 

These  oils  consist  of  a  bland  oil.  Avith  a  variable  quantity  of  an  acrid, 
irritating,  purgative  matter,  which  imparts  to  them  their  characteristic 
properties.  This  irritating  substance  exists  in  a  small  proportion  in 
castor  oil,  and  in  a  larger  degree  in  croton  oil.     Croton  oil  irrit-  tes  the 


OILS. 


245 


skin,  produces  redness,  vesication,  and,  with  a  strong  application,  even 
pustulation,  followed  by  scars.  The  irritating  effect  is  increased  by  the 
admixture  of  alkalies;  hence,  liquor  potassas  is  sometimes  added,  to  in- 
tensify the  effects  of  croton  oil. 

Its  action  is  very  variable;  several  applications  on  successive  clays  may 
produce  but  slight  vesication,  whilst  sometimes  a  single  moderate  applica- 
tion sets  up  great  irritation,  much  vesication,  and  even  pustulation. 
Caution  is  therefore  needful.  When  applied  too  energetically  or  too  per- 
sistently, croton  oil  liniment  sometimes  produces  superficial  papilliform 
white  round  scars,  with  a  hair  follicle  in  the  centre.  These  scars  gradu- 
ally disappear.  Croton  oil  liniment  applied  to  the  chest  of  phthisical  and 
bronchitic  patients,  is  highly  esteemed  as  a  counter-irritant,  but,  owing 
to  the  vesication  it  produces,  it  cannot  generally  be  repeated  more  than 
once  or  twice  on  successive  days,  and  sometimes,  only  one  application  can 
be  borne.  In  bronchitis  and  phthisis,  croton  oil  liniment  is  sometimes 
preferred  to  mustard  poultices,  and,  indeed,  certain  patients  aver  that 
croton  oil  gives  them  greater  relief  than  mustard  poultices.  The  vesica- 
tion, being  a  decided  disadvantage,  the  patient  must  carefully  avoid  con- 
veying any  of  the  croton  application  to  tender  parts  of  the  skin,  lest  it 
should  provoke  troublesome  or  severe  inflammation  of  the  face  or  scrotum. 
Dr.  Tilbury  Fox  states,  that  croton  oil  sometimes  produces  a  symmetrical 
erythema  of  the  face,  lasting  for  a  few  days,  where  no  direct  application 
of  the  drug  could  have  occurred;  and  I  too  have  seen  this  erythema  of 
the  face  occur  during  the  employment  of  croton  oil.  It  is  hard  to  say 
whether  this  erythema  depends  on  the  action  of  the  croton  oil  after  its 
absorption  into  the  blood,  or  on  the  volatile  acrid  principle,  reaching  the 
face  tlirough  the  air,  or  by  means  of  the  hands. 

As  is  the  case  sometimes  with  iodine  liniment,  and  now  and  then  from 
a  bellndonna  plaster,  I  have  known  croton  oil  liniment  produce  a  crop  of 
itching  papules  which  have  spread  over  the  chief  part  of  the  body,  reach- 
ing even  to  the  feet. 

Dr.  Alder  Smith  employs  croton  oil  as  an  application  in  obstinate 
ringworm.  He  says,  '*'  I  generally  put  it  on  a  patch  about  the  size  of  a 
shilling,  with  a  small  camel's  hair  brush,  and  order  a  poultice  to  be  ap- 
plied at  night,  then,  if  it  has  not  set  up  severe  inflammation  and  pustula- 
tion by  the  next  dav,  which  is  very  rare,  I  apply  it  again,  keeping 
poultices  on  constantly  day  and  night.  A  pustular  rash  occurs  at  once, 
biit  the  oil  can  be  applied  over  this,  and  a  daily  application  of  it  for  three, 
six,  or  ten  days,  together  with  constaut  bathing  with  warm  water,  and 
frequent  poulticing  with  linseed  meal,  will  generally  set  up  such  inflam- 
matory exudation,  that  the  patch  resembles  true  kerion."  Dr.  Thin 
draws  attention  to  the  risk  of  this  treatment  causing  j^ermanent  bald- 
ness. The  daily  application  of  castor  oil  is  reputed  to  remove  warts  in 
a  month  or  six  weeks. 

Pure  castor  oil  is  almost  tasteless.  Croton  oil  has  an  acrid  burning 
taste. 

These  oils,  apart  from  their  acrid  principle,  behave  in  the  stomach 
and  intestines,  for  the  most  part,  like  other  oils.  Croton  oil  in  a  large 
dose  inflames  the  stomach.  If  not  quickly  expelled  from  the  intestines, 
they  become  absorbed  into  the  blood,  and  serve  the  same  purposes  as 
other  oils. 

The  acrid  matter  of  these  oils,  irritating  the  mucous  membrane  of 
the  intestine,  excites  slight  catarrh,  and  by  this  means  purges.    As  alka- 


246  OILS. 

lies  intensify  the  action  of  the  acrid  principles,  the  purgative  effect  of 
these  oils  is  heightened  by  admixture  with  the  alkali  of  the  bile. 

Tliese  oils,  especially  castor  oil,  are  commonly  used  as  j^urgatives. 
Castor  oil  is  a  speedy,  certain,  and  somewhat  mild  purgative,  producing 
only  one,  two,  or  three  motions,  with  little  griping.  It  is  said  to  purg-e 
when  injected  into  the  veins,  or  even  when  applied  to  the  skin,  and  if 
this  statement  is  true,  the  oil  must  have  an  esj^ecial  affinity  for  the  intes- 
tines. It  is  commonly  used  as  a  purgative  for  children,  women  with 
child,  after  parturition,  in  fever,  piles,  and  fissure  of  the  anus.  It  is  not 
a  good  purgative  in  habitual  constipation,  as  it  increases  the  torpid  habit 
of  the  bowels,  an  effect  constantly  witnessed  in  children. 

Dr.  Soper  recommends  castor  oil  and  glycerine  in  equal  parts,  and  finds 
wath  this  combination  that  half  a  drachm  of  oil  is  sufficient.  The  oil 
must  be  added  slowly  to  the  glycerine  in  a  mortar,  and  the  mixture  must 
be  well  rubbed  together.     The  taste  of  the  oil  is  covered. 

Croton  oil  is  a  powerful  purgative,  producing  watery  stools,  with  much 
depression.  It  is  an  uncertain  purgative,  sometimes  acting  in  half  an 
hour,  at  other  times  requiring  much  longer.  Large  quantities,  even  six 
or  eight  drops,  may  be  required;  hence  it  is  seldom  used,  unless,  as  in 
apoplexy,  coma,  and  mania,  when  it  is  important  to  administer  a  purga- 
tive of  small  bulk.  It  is  sometimes  employed  in  obstinate  constipation 
when  other  purgatives  have  failed.  It  is  a  good  plan  to  give  a  quarter 
or  a  third  of  a  minim  every  hour,  by  which  means  a  much  smaller  total 
quantity  often  succeeds  better  than  a  larger  quantity  given  in  one  dose. 
Owing  to  its  acrid  taste  it  is  generally  administered  in  the  form  of  a  jiiH, 
except  to  patients  in  a  state  of  insensibility,  when  it  is  mixed  with  a  lit- 
tle butter  or  lard,  and  conveyed  to  the  back  of  the  tongue,  and  is  swal- 
lowed involuntarily,  or  trickles  down  the  throat. 

Kohrig,  from  experimental  evidence,  is  led  to  conclude  that  croton 
oil  given  to  fasting  animals  is  a  powerful  stimulant  to  the  liver,  but 
Kutherford  and  Vignat  did  not  get  this  result  in  their  experiments. 

As  these  oils  remain  but  a  short  time  in  the  intestines,  the  greater 
part  passes  out  with  the  motions.  Probably  little  of  the  acrid  matter 
passes  into  the  blood,  since  unless  croton  oil  is  swallowed  in  large  quan- 
tity, those  serious  symptoms  seen  after  its  injection  into  the  veins  do 
not  occur.  Like  other  purgatives,  these  oils  may  infiueuce  distant  organs, 
as  the  kidneys,  and  act  as  diuretics. 

Croton  oil  has  been  used  in  hydrocephalus,  and  it  is  said  to  have  re- 
moved the  excess  of  fluid  from  the  ventricles  of  the  brain. 

Diarrhoea  in  children  often  yields  to  eight  or  ten  drops  of  castor  oil 
suspended  in  mucilage;  but  unfortunately,  the  indications  for  this  treat- 
ment being  unknown,  it  often  fails. 

In  the  early  stages  of  diarrhoea  it  is  a  common  practice  to  administer 
a  dose  of  castor  oil,  to  carry  away  the  irritant  exciting  the  discharges. 

A  drop  of  castor  oil  introduced  into  the  eye  will  often  allay  pain  and 
intolerance  of  light  produced  by  a  fine  irritant,  as  sand. 

Castor  oil  may  be  taken  almost  if  not  quite  tastelessly  in  beef-tea, 
highly  peppered  and  well  salted;  or  the  oil  may  be  beaten  up  Avith  an 
equal  quantity  of  the  froth  of  porter,  and  tossed  off*  before  the  constitu- 
ents have  separated.  A  mixture  consisting  of  castor  oil,  half  an  ounce; 
fresh  mucilage  of  acacia,  three  drachms;  distilled  water,  five  drachms, 
has  very  little  taste.  It  may  be  flavored  with  oil  of  peppermint  or  oil  of 
lemons.  It  is  a  good  plnn  to  pour  into  a  wetted  glass  the  required  dose, 
and  then  toss  it  off'  without  letting  the  oil  impinge  upon  the  teeth. 


GLYCEKIJSTE.  247 


GLYCERINE. 

The  api^lications  of  glycerine  are  endless.  It  is  antiseptic,  and  pre- 
serves lymph  vaccine  indefinitely.  It  is  a  nseful  application  for  cliapped 
lips  and  hands;  and  for  rough,  furfuraceous,  and  inelastic  skin,  left  after 
eczema,  or  other  skin  complaints.  It  restores  suppleness  to  the  tissues, 
and  allays  burning,  tingling,  and  smarting.  Undiluted  glycerine  may 
cause  inflammation  and  smarting,  hence  it  should  be  mixed  with  an 
equal  quantity  of  rose-water  or  eau  de  Cologne.  Glycerine  of  starch  acts 
still  better  in  renderng  the  skin  soft  and  supple.  In  xeroderma,  a  bath 
should  betaken  daily,  and  the  ointment  rubbed  in  after  wiping  the  body 
thoroughly  dry.  Glycerine  is  a  good  application  for  dryness  of  the 
meatus  of  the  ear;  and  when  the  tymj^anum  is  ruptured,  it  covers  the 
opening  in  the  tym^iiuium  with  a  thin  film,  supplying  for  a  time  the 
j^lace  of  the  lost  membrane. 

Dr.  M.  Rosenthal  recommends  glycerine  as  a  solvent  for  alkaloids 
employed  hypodermically.  One  drachm  of  glycerine  will  dissolve  ten 
grains  of  muriate  of  morphia,  twenty  grains  of  sulphate  of  quinia,  and 
only  one  grain  of  curare. 

The  lips,  tongue,  and  gums,  when  dry  and  coated  with  dried  mucus 
in  acute  diseases,  should  be  washed  and  kej)t  moist  several  times  a  day 
with  glycerine,  Avhich  greatly  improves  the  comfort  and  appearance  of 
the  patient.  If  the  sweet  taste  of  glycerine  is  unpleasant,  it  will  answer 
as  well  if  diluted  with  an  equal  quantity  of  w^ater  or  lemon-juice. 

In  the  last  stage  of  chronic  diseases,  as  phthisis,  when  the  mucous 
membrane  of  the  mouth  becomes  dry,  red,  shiny,  and  glazed,  a  condi- 
tion which  causes  much  distress,  and  is  usually  accompanied  by  great 
thirst,  a  wash  of  glycerine  and  water,  to  rinse  the  mouth,  will  relieve 
this  harassing  condition.  Undiluted,  glycerine  is  apt  to  make  the  mouth 
clammy  and  sticky.     Glycerine  will  sometimes  cure  thrush. 

Glycerine  of  carbolic  acid  is  a  useful  application  to  foetid  sores  and 
open  cancers  of  the  surface  of  the  body,  or  of  the  uterus.  It  removes 
the  offensive  odor  of  the  discharge,  and  improves  the  condition  of  the 
sore. 

A  pledget  of  cotton-wool,  saturated  with  glycerine,  and  ajoplied  for 
several  hours  to  the  congested  neck  of  the  womb,  will  induce  a  copious 
serous  discharge,  and  will  give  as  much  relief  as  the  apj)lication  of 
leeches.  The  pledget  should  be  fastened  with  a  piece  of  twine,  so  that 
the  patient  herself  can  readily  withdraw  it. 

Glycerine  of  borax  is  a  good  application  in  pityriasis  of  the  scalp, 
aphtha?  and  thrush. 

Glycerine  is  much  used  now  in  the  manufacture  of  medicated  pessaries. 

Glycerine  has  been  used  in  place  of  sugar  as  in  diabetes,  but  saccha- 
rine is  far  preferable.  It  has  also  been  recommended  as  a  substitute  for 
cod-liver  oil,  but  experience  has  shown  its  inferiority. 

One  of  the  best  preventives  of  bed-sores  is  glycerine  or  glycerine 
cream.  The  part  exposed  to  pressure  should  be  washed  morning  and 
evening  with  tepid  water,  and  carefully  dabbed  quite  dry  with  a  soft 
towel,  and  then  gently  rubbed  over  with  a  little  glycerine  or  glycerine 
cream.     If  the  skin  is  sore  or  tender,  the  glycerine  cream  is  best.     A 


248  TANNIN. 

draw-sheet  made  of  linen,  and  sufficiently  large  to  be  firmly  tucked  in 
at  both  sides  of  the  bed  (as  any  folds  or  creases  are  very  apt  to  produce 
tenderness,  and  eventually  sores),  will  prevent  soiling  of  the  bed-clothes. 
This  preventive  treatment  should  be  commenced  before  the  on-coming 
of  redness  or  tenderness. 

It  relieves  greatly  when  ajoplied  to  the  mucous  membrane;  in  acute 
coryza  vaseline  is  preferable. 

Glycerine  I  find  useful  in  stomach  flatulence  and  acidity,  a  drachm 
to  two  drachms  should  be  taken  several  times  a  day  in  tea,  coffee,  or 
water,with  food. 

A  teaspoonful  of  glycerine  neat,  or  added  to  water,  is  often  useful  in 
coughs,  even  the  cough  of  phthisis.  It  may  be  added  to  a  little  lemon- 
juice,  which  makes  it  more  efficacious  in  some  cases.  This  taken  at 
night  often  lessens  morning  cough.  It  also  is  useful  in  dry  throats.  A 
drachm  used  as  an  anal  injection  is  useful  to  relieve  the  bowels  in  con- 
stipation. A  very  large  dose  produces  hgemoglobinuria,  from  destruc- 
tion of  the  red  corpuscles. 


TANNIN   AND   ITS   COMPOUNDS.     ON   GALLIC   ACID. 

These  substances  produce  little  or  no  change  on  the  unbroken  skin, 
but  act  as  astringents  to  sores  and  mucous  membranes,  checking  secre- 
tion by  contracting  the  vessels  and  condensing  the  tissues.  Rossbach, 
however,  maintains  that  the  vessels  are  dilated  but  not  paralyzed,  for 
they  contract  on  stimulation.  They  precipitate  albumen,  and  thus  coat 
over  wounds,  in  some  measure  protecting  them  from  the  injurious  action 
of  the  air,  whence  tannin-containing  substances  are  applied  to  excoria- 
tions, profusely-discharging  sores,  and  luxuriant  granulations.  Tannin 
is  conveniently  employed  in  the  form  of  glycerine  of  tannin.  This  com- 
bination is  useful  in  oza^na.  After  measles,  scarlet  fever,  and  some  other 
diseases,  the  inside  of  the  nose  not  uncommonly  becomes  excoriated  and 
reddened,  and  discharges  freely  a  thin  sanious  or  thicker  purulent  fluid, 
which,  on  drying,  scabs  up  the  nose,  and  often  excites  eczema  of  the 
upper  lip;  now,  if  the  inside  of  the  nose  is  well  brushed  out  with  glyc- 
erine of  tannin,  the  discharge  will  cease,  even  after  a  single  application; 
but  if  the  scabs  are  thick,  they  must  be  thoroughly  removed,  to  enable 
the  application  to  act  on  the  secreting  soi'e  surface.  Glycerine  of  tan- 
nin is  useful  in  syphilitic  oza^na  of  cliildren;  it  arrests  tlie  discharge,  re- 
duces the  swelling  of  the  mucous  membrane  which  produces  the  charac- 
teristic sniffling,  and,  by  enabling  the  child  to  breathe  through  the  nose, 
permits  sound  refreshing  sleep  and  effective  suckling. 

Occasionally  among  adults  we  meet  with  an  impetiginous  eruption 
of  the  inside  of  the  nose,  most  severe  near  the  orifice  where  the  hairs 
grow,  but  extending  higher  in  a  milder  form.  Scabs  block  up  the  nose, 
especially  at  night,  and  the  ala?,  and  sometimes  tlie  whole  of  the  nose,  is 
tliickened,  dusky  red,  and  very  painful.  The  swelling  may  extend  to 
the  ad ji) cent  structures,  and  may  merge  into  repeated  attacks  of  erysip- 
elas of  the  face.  Glycerine  of  tannin,  ap])lied  once  or  twice  daily  to  the 
whole  cavity  of  the  nose,  speedily  reduces  and  even  cures  this  disease. 
The  upper  part  of  the  nose  is  the  most  easily  cured,  but  the  disease  situ- 


TANNIN.  249 

ated  iu  the  hairy  part  is  much  more  obstinate,  and  is  very  prone  to  recur 
again  and  again.  Epilation  is  useful  in  obstinate  cases.  Glycerine  of 
starch  or  zinc  ointment,  applied  several  times  a  day,  keeps  the  tissues 
moist  and  supjile,  and  is  a  serviceable  supplementary  application. 

Glycerine  of  tannin  will  generally  cheek  the  nasal  discharge  of  thick, 
hnnpy,  greenish-black,  and  stinking  mucus,  and,  even  when  it  fails,  it 
ordinarily  removes  the  offensive  smell.  In  other  forms  of  oza?na,  esjje- 
cially  when  the  disease  aifects  the  upper  and  back  part  of  the  nose  with 
its  numerous  recesses,  it  is  preferable  to  flush  the  nose  with  a  deodoriz- 
ing and  astringent  wash;  which,  besides  benefiting  the  mucous  mem- 
brane, washes  away  the  inspissated  putrefying  discharge  on  which  the 
stench  of  ozasna  generally  depends. 

Glycerine  of  tannin  is  very  valuable  in  otorrhoea,  acommon  compLiint 
of  weak,  unhealthy  children  after  severe  illnesses.  The  external  meatus 
must  be  filled  with  it,  and  retained  there  by  cotton-wool.  One  applica- 
tion usually  suffices,  but  a  slight  discharge  may  remain,  or  return  in  a 
few  weeks,  when  a  repetition  of  the  treatment  is  called  for.  This  treat- 
ment is  inaiiplicable  in  the  acute  stages  of  inflammation  of  the  meatus. 
This  affection  is  much  more  difficult  to  cure  when  the  tympanum  is  de- 
stroyed and  the  small  bones  are  exposed;  indeed,  in  such  cases,  the  tan- 
nin only  restrains  and  deodorizes  the  discharge,  which  generally  returns 
when  the  application  is  stopped.  Glycerine  of  tannin  will  often  cure  the 
chronic  vaginitis  of  children,  a  complaint  generally  more  obstinate  than 
either  oza3na  or  otorrhooa. 

Glycerine  of  tannin  is  useful  in  some  stages  of  eczema.  After  the 
removal  of  the  scales,  if  the  inflamed,  red,  swollen,  and  weeping  raw  sur- 
face is  painted  with  this  prejmration,  it  notably  abates  the  discharge, 
redness,  heat,  and  swelling.  A  jDoultice  must  be  applied  at  night:  if  the 
glycerine  of  tannin  excites  much  pain,  the  j^oultices  must  be  continued 
night  and  day.  In  a  less  active  stage,  when  the  tissues  are  not  so  red, 
swollen,  and  weeping,  eczema  yields  still  more  readily  to  glycerine  of 
tannin,  applied  twice  or  thrice  daily.  A  poultice  is  useful  at  night. 
Tannin  glycerine  quickly  allays  the  trouldesome  itching,  tingling,  and 
burning,  so  common  in  eczema;  hence  it  prevents  tearing  with  the  nails 
and  rubbing,  which  hinder  healing,  nay,  even  cause  the  eczema  to  spread. 
It  may  not  entirely  remove  the  disease,  but  only  reduce  it  to  the  desqua- 
mative stage,  with  a  tendency  to  crack  and  ooze,  when  tar,  carbolic  acid, 
or  other  ointments  become  necessary  to  complete  the  cure.  The  same 
treatment  is  useful  in  impetigo.  A  poultice  must  be  ajiplied  each  night 
fo  remove  the  scabs,  and  the  tannin  application  should  be  employed  dur- 
ing the  day.  While  treating  these  skin  diseases,  the  state  of  the  digestive 
organs  must  not  be  overlooked. 

Eczema  of  the  ears,  common  in  middle-aged  and  old  people,  readily 
yields  to  glycerine  of  tannin,  unless  the  inflammation  runs  high,  with 
great  swelling,  heat,  and  weeping.  This  remedy  is  also  very  efficacious 
in  eczema  behind  the  ears  of  children,  one  or  two  applications  speedily 
drying  up  and  healing  the  eczema,  although  it  niay  have  lasted  for  weeks 
or  months.  The  gums  must  be  lanced,  if  red  and  swollen,  and  other  ir- 
ritations removed. 

Glycerine  of  tannin  sometimes  benefits  intertrigo. 

Equal  parts  of  tincture  of  catechu  and  liquor  plumbi  is  a  useful  ap- 
plication to  prevent  bed  sores. 

The  following  is  an  excellent  pomatum  for  dandruff'. — Tannic  acid. 


250  TANNIN. 

3j;  glycerine,  3  ss;  prepared  lard,  3j;  balsam  of  Peru,  20  drops;  oil 
of  bitter  almonds,  four  drops. 

Glycerine  of  tannin  is  very  useful  in  many  throat  diseases.  Imme- 
diately after  acute  inflammation,  when  the  mucous  membrane  grows 
less  red,  less  swollen,  becomes  moister,  and  is  covered  with  mucus  or 
pus,  glycerine  of  tannin  painted  on  the  pharynx,  hastens  recovery,  pre- 
vents chronic  inflammation  with  relaxation  of  the  mucous  membrane, 
which  often  follows  the  acute  disease,  heals  superficial  ulcerations  occur- 
ring as  the  acute  inflammation  subsides,  and  cures  hoarseness.  It  causes 
dryness  of  the  mouth  and  lessens  the  sensitiveness  of  the  nerves,  both 
of  ordinary  and  special  sensation. 

Glycerine  of  tannin  is  useful  on  the  appearance  of  ulceration  in 
aphthous  sore  throat.  In  chronic  inflammation  of  the  throat  when  the 
mucous  membrane  is  relaxed,  swollen,  granular-looking,  and  covered 
with  mucus  or  pus,  a  few  ajiplications  of  glycerine  of  tannin  brace  up 
the  tissues  and  lessen  or  remove  the  hoarseness.  This  kind  of  throat, 
often  with  slight  enlargement  of  the  tonsils,  is  common  in  children, 
and  sometimes  produces  deafness,  and  still  more  often  a  frequent  hack- 
ing cough,  which  may  keep  the  child  awake  the  greater  part  of  the 
night.  In  children,  this  is  so  commonly  the  cause  of  cough,  that  it  is 
well  always  to  examine  their  throats.  Glycerine  of  tannin  ajjplied  daily 
speedily  allays  the  cough  and  cures  the  deafness.  Throat  deafness  is 
the  most  common  form  of  that  inflrmity  in  childhood;  and  when  not 
due  to  enlarged  tonsils,  generally  depends  ujjon  the  kind  of  morbid 
throat  just  described. 

Many  coughs  depend  on  the  state  of  the  throat,  a  fact  accepted  in 
theory,  but  little  regarded  in  practice.  Glycerine  of  tannin  is  very  use- 
ful to  allay  the  cough  and  frequent  deglutition  excited  by  an  elongated 
uvula,  and  the  frequent  hacking  cough  in  phthisis ,  due  to  inflammation 
or  ulceration  of  the  throat.  A  good  night's  rest  may  be  often  obtained  by 
painting  the  throat  shortly  before  bedtime,  and  a  small  quantity  of  mor- 
phia added  to  the  glycerine  of  tannin  increases  its  soothing  effect,  Mop- 
2)ing  the  pharynx,  epiglottis,  and  adjacent  structures  with  this  applicci- 
tion  will  much  reduce  the  frequency  and  violence  of  the  paroxysms  of 
whooping-cough.  It  is  of  little  use  if  the  case  is  complicated  with 
catarrhal  or  other  inflammation  of  the  lungs,  tuberculosis,  or  any  irrita- 
tion, as  that  from  teething;  but  in  simjole  uncomplicated  whooping-cough 
it  is  very  useful.  The  paroxysmal  cough  often  left  by  whooping-cough, 
which  readily  returns  on  catching  cold,  yields  to  this  treatment.  Ii^ 
whooping-cough  and  the  foregoing  throat  diseases,  glycerine  of  tannin 
is  better  than  a  solution  of  nitrate  of  silver,  as  it  excites  less  pain,  and  is 
less  disagreeable  to  the  taste.  (See  Nitrate  of  Silver).  Glycerine  of 
tannin  is  more  efiicacious  than  tannin  lozenges. 

Glycerine  of  tannin  is  useful  in  ulcerative  stomatitis,  especially  in 
that  form  affecting  only  the  edges  of  the  gums;  but  dried  alum  is  a  bet- 
ter application.     (See  Salicine.) 

In  diphtheria  and  croup,  Trousseau  successfully  employed  a  solution 
containing  five  per  cent,  of  tannin,  in  the  form  of  spray  several  times  a 
day,  for  fifteen  or  twenty  minutes. 

Tannin  unites  with  albuminous  matter  in  the  stomach,  forming  an 
insoluble  substance,  and  any  tannin  left  uncombined  constringes  the 
mucous  membrane,  and  lessens  its  secretions.  As  tannin  likewise  dimin- 
ishes the  solvent  power  of  the  gastric  juice,  it  is  inadvisable  to  give  tan- 


TANNIIST.  251 

nin-containing  substances  close  to  meal  times.  It  is  asserted  that  taimin, 
by  virtue  of  its  astringeiicy,  cures  slight  catarrh  of  the  stomach;  hence 
tannin  preparations  are  occasionally  employed  in  irritative  dyspepsia. 
Some  give  tannin  for  pyrosis,  but  they  do  not  discriminate  whether  it 
checks  neutral,  alkaline,  or  acid  pyrosis,  or  all  these  forms  of  the  com- 
plaint. In  poisoning  by  alkaloids,  as  strychnine  and,  morphia,  tannin  is 
given  to  render  them  less  soluble.  Tannin  controls  bleeding  from  the 
stomach ;  it  should  be  given  in  large  doses  of  gr.  x  to  gr.  xx.  The  mem- 
bers of  this  group  are  astringent  to  the  intestines,  lessening  their  secre- 
tions and  probably  their  contractions :  hence  they  constipate,  and  tan- 
nin-containing substances,  as  catechu,  kino,  red  gum,  rhatany,  and 
ha^matoxylnm,  are  very  useful  in  most  forms  of  acute  and  chronic  diar- 
rhoea. The  members  of  this  group  are  employed  as  anal  injections  to 
check  diarrhoea,  to  destroy  thread-worms  and  to  restrain  prolapsus  ani. 

Few  applications  are  so  useful  in  irritable  piles  as  gallic-acid  and 
opium  ointment.  The  combination  quickly  relieves  pain,  and  after  a 
time  even  reduces  the  size  of  the  ha3morrhoidal  tumors.  Calomel  oint- 
ment, too,  is  highly  useful. 

Owing  to  their  low  diffusion  power,  the  members  of  this  group  must 
pass  but  slowly  from  the  intestines  into  the  blood.  For  topical  action 
on  digestive  mucous  membrane  tannin  is  best,  but  gallic-acid  is  best  to 
influence  distant  organs.  After,  if  not  before,  absorption  into  the  cir- 
culation, they  must  become  neutralized  with  albumen,  and  for  this  rea- 
son some  authorities  maintain  that  tannin  and  its  allies  do  not  act  as  as- 
tringents to  organs  distant  from  the  intestines.  Nevertheless,  tannin 
and  gallic-acid  are  frequently  em2)loyed  with  considerable  benefit  to  clieck 
bleeding  from  the  lungs,  uterus,  and  kidneys.  Bartholow  states  it  is  es- 
pecially useful  in  bleeding  from  the  kidneys,  and  is  less  beneficial  in 
checking  over-abundant  secretion  of  milk,  and  profuse  sweating. 

Tannin  is  sometimes  administered  to  diminish  the  loss  of  albumen 
in  chronic  Bright's  disease,  and  George  Lewakl  has  experimentally  tested 
its  power  in  this  respect.  In  a  few  carefully-conducted  experiments,  he 
found  that  the  albumen  was  always  lessened  to  an  inconsiderable 
amount,  the  daily  average  diminution  amounting  to  about  0.66  gramme. 
Tannin  produced  a  much  more  decided  increase  in  the  quantity  of  urine. 

An  injection  of  glycerine  of  tannin  is  very  beneficial  in  the  after- 
stages  of  gonorrhoea,  and  in  gleet,  but,  as  the  undiluted  preparation 
commonly  excites  much  pain,  it  should  be  mixed  with  an  equal  quantity 
of  olive  oil  or  mucilage.  Two  drachms  of  this  mixture  is  enough  for 
each  injection.  Too  much  Avill  excite  frequent  and  painful  micturition; 
the  discharge  in  many  instances  ceases  only  during  its  employment. 
Urethral  injections  should  be  persevered  with  eight  or  ten  days  after 
the  cessation  of  discharge,  and  as  they  are  apt  to  excite  seminal  emissions, 
should  not  be  employed  at  bedtime. 

Tannin,  either  alone  or  blended  with  other  astringents,  is  a  useful 
injection  in  leucorrhoea.  In  obstinate  cases,  and  when  the  os  uteri  is 
ulcerated,  a  suppository  of  tannin  and  cocoa-nut  fat  applied  to  the  mouth 
of  the  uterus  is  very  beneficial.  Glycerine  of  tannin  checks  the  great 
discharge  of  cancer  of  the  uterus,  and  destroys  the  stench :  but  a  mixt- 
ure of  glycerine  of  tannin  and  glycerine  of  carbolic  acid  is  still  more 
useful. 

The  effect  of  the  members  of  this  group  on  the  natural  constituents 
of  the  urine  is  unknown.     Gallic-acid  ''passes  unchanged  into  the  urine. 


252  HAMA.MELIS    VIKGINICA. 

and  liiis  been  detected  one  hour  after  being  taken."  Tannic  acid  "  passes 
off  by  the  urine  in  the  forms  of  gallic  and  pyrogallic  acids,  perhaps  of  a 
saccharine  body."     (Parkes.) 


HAMAMELIS   VIRGINICA. 

Two  preparations  of  this  plant  are  largely  used.  A  tincture  and  a 
preparation  called  hazeline.  Pond's  extract,  too,  owes  its  virtues  to  this 
plant. 

Various  preparations  of  witch  hazel  have  long  been  in  vogue  in 
America  among  the  natives,  who  introduced  it  to  the  English  settlers. 

It  is  largely  used  in  haemorrhage,  and  is  most  serviceable  in  passive 
hsemorrhage,  or  in  bleeding  (oozing)  from  small  vessels. 

Applied  on  lint  or  cotton  wool,  it  is  useful  for  bruises,  also  for  oozing 
from  wounds  and  sores. 

It  is  also  very  useful  in  various  ha3morrhages  when  taken  by  the 
stomach,  and  thus  administered  is  useful  often  in  epistaxis,  lia3moptysis, 
and  hsematemesis.  It  has  been  recommended  in  the  hajmorrliagic  dia- 
thesis; but  in  the  case  of  a  lad  with  this  peculiarity,  I  employed  it  on 
several  occasions  in~vain  in  nose  bleeding. 

It  is  useful  in  purpura,  and  I  have  seen  severe  cases  much  benefited 
by  a  drachm  of  the  tincture  given  hourly,  though,  in  most  cases,  half 
this  dose  is  sufficient.  Dr.  Hill  recommends  it  in  dysentery,  when  the 
discharges  contain  much  blood.  I  have  known  it  in  several  cases  arrest 
hsematuria  when  other  remedies  had  failed. 

It  is  very  useful  too  in  some  forms  of  menorrhagia.  The  dose  is  two 
drachms  of  hazeline  twice  or  thrice  a  day.  It  often  relieves  the  pain  of 
dysmenorrhoea. 

An  obstinate  case  of  bleeding  from  the  bladder,  due  probably  to  a 
vascular  growth,  was  cured  by  injecting  twice  daily  into  the  bladder  half 
an  ounce  of  hazeline. 

It  is  very  valuable  for  piles.  It  rarely  fails  to  check  bleeding  from 
piles,  even  when  administered  by  the  mouth.  But  its  effect  is  much  en- 
hanced by  injecting  half  a  drachm  to  a  drachm  of  the  tincture  in  an 
ounce  of  cold  water  daily,  as  in  the  morning  before  rising. 

It  not  only  checks  bleeding,  but  if  this  treatment  is  persisted  in  for 
several  months  it  permanently  relieves  or  even  cures  piles  that  are  not 
very  large.  It  has  been  employed  successfully  in  varicocele,  and  one  case 
I  have  seen  in  which,  during  the  employment  of  the  drug,  the  varicosi- 
ties entirely  and  apparently  permanently  disappeared. 

Dr.  Preston  extols  it  in  phlegmasia  dolens. 

It  is  useful,  too,  in  catarrh  of  the  mucous  membrane,  and  snuffed  up 
the  nose  it  is  beneficial  for  colds  in  the  head  and  in  hay  fever. 

Dr.  Hector  Guy  investigated  the  pliysiological  action  of  this  useful 
and  interesting  drug,  and  found  that  it  is  not  tonic  in  very  large  doses, 
and  that  it  has  no  action  on  the  heart,  arteries,  or  veins.  The  active 
j)rinciple  is  probable  an  essential  oil.  It  contains  no  alkaloid.  Drs. 
Wood  and  Marshall,  experimenting  with  a  strong  distillate,  were  unable 
to  obtain  any  jDhysiological  effects.     It  contains  much  tannin  and  gallic 


TAR,    CREASOTE.  253 

acid,  and  some  ascribe  its  virtue  to  these  substances;  but  tlie  distillate 
is  efficacious,  and  this  contains  only  the  volatile  oil. 

In  the  earlier  editions  of  this  work  I  recommended  one  or  two  min- 
ims of  the  tincture  every  two  or  three  hours,  and  this,  in  many  cases,  is 
quite  sufficient  to  check  bleeding,  but  much  larger  doses  will  succeed 
when  these  small  quantities  fail.  But  large  doses  sometimes  cause  severe 
headache. 


GOTO  BAKK. 


Of  this  plant  the  tincture  in  ten-minim  doses,  or  the  alkaloid  cotoin  in  half-gi*ain 
to  two-gn-ain  doses,  or  the  powder  in  one  to  ten-grain  doses  several  times  a  day  is 
the  usual  dose. 

It  is  highly  recommended,  especially  by  Albertini,  in  all  forms  of  diarrhoea,  acute 
and  chronic,  even  the  diarrhoea  of  phtiiisis.  It  is  larg-ely  used  by  some  in  the  diar- 
rhoea of  infants.     Said  to  be  useless  in  the  diarrhcea  of  drunkards  and  from  cirrhosis. 

Albertini  says  it  increases  appetite  and  augments  venous  pressure,  and  excites 
active  hj^pertemia  of  the  abdominal  organs.  It  is  reputed  to  check  salivation  and 
the  sweating  of  phthisis. 

The  powder  irritates  the  nose.  From  an  allied  bark,  paracotoin  is  obtained; 
which  is  used  in  similar  cases  and  employed  in  similar  doses  as  cotoin. 


PETROLEUM.    VASELINE,   &c. 

Since  vaseline  remains  unchanged  by  exposure  to  the  air,  it  is  highly 
useful  for  lubricating  the  skin  when  it  is  dry  or  hard,  as  in  psoriasis, 
chronic  eczema,  xeroderma,  chapped  hands,  sunburn.  It  is  excellent  in 
many  cases  of  chronic  eczema  where  the  skin  is  dry  and  scaly.  01  delena 
I  have  seen  very  useful  in  these  cases. 

As  it  is  not  absorbed  by  the  skin  it  is  not  the  best  vehicle  for  medi- 
cines, like  aconitia,  veratria,  etc.,  and  is  used  only  with  those  substances, 
as  lead,  mercury,  zinc  and  iodide  of  sulphur,  which  make  lard  rancid. 

Petrolettm,  or  benzin,  are  jDopularly  used  as  local  applications  in 
chronic  rheumatism,  and  appear  to  be  of  considerable  service. 


TAR.     CREASOTE,   &c. 

The  empyreumatic  oils,  and  their  derivatives,  are  very  useful  in  many 
chronic  skin  affections,  as  chronic  eczema,  psoriasis,  erythema.  The  odor 
of  oil  of  cade,  or  oleum  rusci,  is  less  disagreeable  than  that  of  tar,  liquor 
carbonis  detergens,  and  carbolic  acid.  Dr.  McCall  Anderson  strongly 
recommends  these  oils,  especially  liquor  carbonis  detergens,  oil  of  cade, 
and  oleum  rusci.  In  most  cases  they  afford  immediate  relief  from  the 
tormenting  itchiu/g  of  chronic  eczema,  psoriasis,  erythema,  and  prurigo, 
but  if  too  long  continued  they  excite  inflammation  of  the  hair  follicles, 
forming  papules  and  pustules,  with  a  black  spot  in  their  centre.     Hebra 


254  TAR,    CREASOTE. 

terms  this  eruption  tar  acne.  They  often  excite  considerable  inflam- 
mation in  delicate  skins.  The  topical  effect  of  the  vapor  even  sometimes 
produces  acne.  The  parts  protected  by  clothes  escape,  showing  that  this 
effect  is  not  induced  througli  absorption  by  the  lungs. 

These  oils  are  useful  in  chronic  eczema,  after  the  subsidence  of  in- 
flammation, especially  Avhen  only  a  little  redness,  itching,  and  some  des- 
quamation remain.  Sometimes  pure  tar  succeeds  better  than  its  oint- 
ment ;  but  if  there  is  inflammation,  or  if  the  surface  is  raw  and  weeping, 
it  will  then  excite  great  pain  and  inflammation.  In  some  instances  the 
application  of  undiluted  petroleum  much  improves  local  forms  of  eczema, 
as  that  kind  occurring  on  the  back  of  the  hands;  but  as  this  apj^lication 
is  generally  very  painful,  other  and  milder  remedies  should  first  be  tried. 

The  external  apjilication  of  tliese  remedies  in  psoriasis  is  often  very 
serviceable.  Tar,  or  its  ointment,  seldom  fails  to  benefit  chronic  jDsoriasis ; 
and  some  of  the  most  obstinate  forms  of  this  disease  may  often  be  cured 
by  jiainting  the  patches  of  the  eruption  with  pure  undiluted  tar,  allow- 
ing it  to  remain  till  it  wears  gradually  away.  If  the  unsightliness  of  the 
tar  ointment  is  objectionable,  the  creasote  ointment,  composed  of  two  or 
three  jDarts  of  creasote  to  one  part  of  white  wax,  recommended  by  Mr. 
Squire,  may  be  substituted.  This  powerful  ointment  must  be  applied 
only  to  the  patch  of  psoriasis,  not  on  the  adjacent  healthy  skin,  otherwise 
it  will  blister.  To  avoid  staining  exposed  parts,  Dr.  McCall  Anderson 
sponges  the  eruption  three  or  four  times  daily  with  a  wash  composed  of 
crystallized  carbolic  acid,  two  drachms;  glycerine,  six  drachms;  rectified 
spirits,  four  ounces;  distilled  water,  one  ounce.  But  he  considers  car- 
bolic acid  inferior  to  tarry  preparations.  He  strongly  insists  on  the 
necessity  of  rubbing  in  the  ointments  till  they  have  nearly  disappeared, 
and,  lest  they  become  rancid,  of  washing  them  off  with  soajD  and  water 
before  each  fresh  apjilication. 

Petroleum  soap,  cade  soap,  and  carbolic  soap  are  useful  in  both  chronic 
eczema  and  psoriasis.  As  these  soaps  are  made  of  different  strengths,  if 
one  kind  prove  too  strong  and  irritating  a  milder  form  may  be  substituted. 

The  inhalation  of  creasote  or  carbolic  acid,  ten  to  twenty  drops  in 
boiling  water,  is  useful  in  bronchitis,  lessening  in  some  cases  over-abun- 
dant expectoration.  It  will  generally  remove  the  breath  fcetor  occasion- 
ally met  with  in  bronchitis,  and  sometimes  even  the  fcetor  due  to  gan- 
grenous lung.  The  inhalation  of  even  ten  drops  produces  in  some 
l^ersoas  giddiness  and  sensation  of  intoxication.  Inhalation  of  carbolic 
acid  with  steam,  or  in  spray,  is  useful  in  whooi3ing-cough.  Used  in  an 
oro-nasal  inhaler,  twice  or  three  times  a  day,  for  a  quarter  to  half  an 
hour,  creasote  in  5  to  10  minim  doses  is  very  efficient  in  easing  the  cough 
of  chronic  johthisis  and  chronic  bronchitis.  It  seems  especially  useful 
where  the  cough  is  violent  and  protracted,  and  out  of  all  proportion  to 
the  amount  of  expectoration,  when,  indeed,  the  cough  seems  largely  to 
depend  on  an  excitable  state  of  the  nerves.  Its  effect  is  often  rapid  and 
complete;  in  fact  I  know  of  no  remedy  that  affords  in  some  cases  so 
much  and  such  rapid  relief.  I  have  seen  it  relieve  the  violent  cough 
accompanying  plastic  bronchitis. 

Creasote,  mixed  either  with  tannin  or  opium,  introduced  into  the 
hollow  of  a  decayed  and  painful  tooth,  often  gives  relief. 

A  creasote  or  carbolic  gargle  or  wash  proves  very  efficacious  in 
sloughs  of  the  mouth  or  throat,  removing  the  offensive  odor,  and  pro- 
ducing a  healthier  action  in  the  sore. 


TAR,    CREASOTE.  255 

Small  closes  of  creasote  excite  no  particular  symptoms  in  the  stomach, 
but  a  large  quantity  produces  a  sensation  of  burning  at  the  epigastrium, 
with  nausea  and  vomiting. 

During  its  transit  through  the  intestines,  creasote  aj^pears  not  to  un- 
dergo any  cliange  in  composition,  as  its  characteristic  odor  may  be  de- 
tected in  every  part  of  the  canal.  It  checks  the  vomiting  of  various 
diseases,  as  that  of  pregnancy,  sea-sickness,  cancer,  ulcer  of  the  stomach, 
Bright's  disease.  It  often  promptly  relieves  stomach  pains  occurring 
after  food. 

Creasote  has  been  given  in  cholera  and  typhus  fever,  but  apj^arently 
without  much  benefit. 

Creasote  passes  into  the  blood,  and  its  odor  is  detectable  in  most  of 
the  organs,  showing  that  it  probably  remains  in  chief  part,  if  not  en- 
tirely, unaltered  in  the  blood. 

Tar,  creasote,  and  carbolic  acid  are  used  in  bronchitis  and  in  phthi- 
sis to  check  both  the  quantity  of  the  expectoration  and  its  offensiveness. 
They  are  especially  useful  in  chronic  bronchitis.  Tar-water  is  an  old- 
fashioned  and  approved  remedy  in  bronchial  complaints.  The  frequent 
and  popluar  use  of  tar-water,  both  by  the  profession  and  by  the  laity  in 
Trance  and  Belgium,  led  me,  in  conjunction  with  Dr.  Murrell,  to  try  its 
elfects.  Patients  so  susceptible  to  cold  that  they  were  obliged  to  remain 
indoors  the  whole  winter  informed  us  that  this  remedy  curtailed  con- 
siderably the  duration  and  lessened  the  severity  of  their  catarrhal  attack, 
and  that,  by  an  occasional  recourse  to  the  tar,  they  became  less  prone  to 
catch  cold,  and  could  more  freely  expose  themselves  to  the  weather. 

We  employed  tar  in  two-grain  doses,  in  a  inll,  every  three  or  four 
hours.  From  October  to  January,  inclusive,  we  carefully  watched  its 
effects  on  twenty  five  patients,  whose  ages  varied  from  thirty-four  to 
seventy,  the  average  being  forty-four.  All  these  patients  had  suffered 
for  several  years  from  winter-cough,  lasting  the  whole  winter.  They 
were  out-patients,  and  visited  the  hospital  weekly,  or  oftener.  Most  of 
them  were  much  exposed  to  the  weather,  while  some,  being  so  ill,  were 
obliged  to  stop  work,  and  therefore  were  less  exposed. 

These  patients  suffered  from  the  symptoms  common  in  winter  cough 
— paroxysmal  and  violent  cough,  the  paroxysms  lasting  from  two  to  ten 
minutes,  recurring  ten  to  twelve  times  a  day,  and  in  the  night  spoiling 
sleep.  The  expectoration,  frothy  and  slightly  purulent,  was  generally 
rather  abundant,  amounting  in  some  cases  to  half  a  pint  or  more  in  the 
day.  The  breathing  was  very  short  on  exertion,  but  most  of  them  could 
lie  down  at  night  without  propping.  The  physical  signs  showed  a  vari- 
able amount  of  emphysema  with  sonorous  and  sibilant  rhonchus,  and 
occasionally  a  little  bubbling  rhonchus  at  the  base. 

These  patients  usually  began  to  improve  from  the  fourth  to  the 
seventh  day;  the  improvement  rapidly  increased,  and  in  about  three 
weeks  they  were  well  enough  to  be  discharged.  The  improvement  was 
so  decided  that  the  patients  returned  to  their  work;  even  those  who,  in 
previous  years,  had  been  confined  to  the  house  the  whole  winter.  The 
cough  and  expectoration  improved  before  the  breathing.  In  several  cases 
the  expectoration  increased  during  the  first  three  or  four  days ;  but  its 
expulsion  became  easier,  and  with  the  improvement  in  the  cough  and  ex- 
pectoration, appetite  and  strength  returned. 

On  discontinuing  the  tar,  a  relapse  often  occurred  in  a  week  or  two, 
and  the  patient  returned  with  a  request  for  more  of  the  same  medicine. 


25G  CARBOLIC     ACID. 

and  then  a  second  time  the  symptoms  quickly  subsided.  AVe  found  it 
useless  in  bronchial  asthma,  and  its  effects  were  more  evident  in  cases 
where  expectoration  and  cough  were  more  marked  than  dyspnoea. 

We  have  no  doubt  that  tar  is  a  good,  useful,  though,  perhaps,  not  a 
striking,  remedy  in  these  troublesome  affections;  and  certainly  it  is  more 
efficacious  than  the  drugs  generally  employed. 

It  may  be  remarked  that  tar  is  useful  in  the  same  cases  for  which  the 
spray  of  ipecacuanha  wine  is  serviceable.  The  spray,  we  find,  acts  much 
more  quickly  and,  unlike  tar,  it  lessens  dyspnoea  even  before  it  improves 
cough,  or  diminishes  expectoration. 

Creasote  in  full  doses  is  strongly  recommended  in  phthisis,  especially 
for  the  non-febrile  or  only  slightly  feverish  cases.  It  is  said  to  diminish 
expectoration,  imi^rove  appetite,  and  increase  weight. 

Dr.  Anderson  gives  tar  m  chronic  eczema.  He  begins  with  three  or 
four  minims  in  treacle,  pill  or  capsules,  gradually  increasing  the  dose  to 
ten  or  fifteen  minims  three  times  a  day.  In  gangrene  of  the  lungs  crea- 
sote is  employed  to  obviate  the  foetor  of  the  expectoration,  and  as  an  in- 
halation it  certainly  succeeds,  though  when  swallowed  it  is  of  doubtful 
efficacy. 

Oppression  of  the  head,  epigastric  jiain,  vomiting  of  dark  colored  fluid, 
and  black  motions  sometimes  occur  after  the  application  of  tar,  though 
rarely  except  when  applied  over  a  large  area. 

Tar  and  creasote  are  reputed  to  be  diuretics;  and,  as  some  of  the  in- 
gredients of  tar  pass  off  with  the  urine,  changing  its  color  and  odor,  they 
may  possibly  act  on  the  urinary  tract.  Thus  tar,  creasote,  and  carbolic 
acid,  administered  either  internally,  or  applied  externally,  cause  some- 
times at  first  dark-colored,  and  sometimes  black  urine,  which  gradually 
becomes  lighter  in  tint.  It  is  said  that  the  urine  is  colored  dark  more 
frequently  from  the  external  than  from  tiie  internal  use  of  carbolic  acid; 
and  Ferrier  suggests  that  this  is  owing  to  its  becoming  oxidized  before 
its  absorption.  Sometimes  the  urine  is  natural  in  color  when  first  passed, 
but  becomes  dark  on  standing.  On  the  addition  of  sulphuric  acid,  the 
odor  of  tar  is  readily  perceived,  and  chloride  of  iron  develops  a  beautiful 
blue  color.  The  local  application  of  ol  fagi,  ol  rusci,  ol  cadini,  occasion- 
ally affects  the  urine  in  the  same  manner.  The  urinary  changes  are  es- 
pecially marked  within  the  first  few  days,  but  after  a  time  these  changes 
become  scarcely  perceptible.  The  urine  remains  clear  throughout,  rarely 
contains  albumen,  and  does  not  exhibit  an  excess  of  iron,  showing  that 
the  discoloration  is  not  due  to  disintegrated  blood  corpuscles.  The  urine, 
in  health,  contains  a  trace  of  carbolic  acid.  Carbolic  acid  and  creasote 
sometimes  excite  strangury.  Carbolic  acid  and  sulpho-carbolates  admin- 
istered by  the  stomach  prevent,  as  we  have  shown,  decomposition  of  the 
urine;  possibly  these  drugs  may  prove  useful  agents  to  preserve  the  urine 
sweet  in  cystitis,  enlarged  prostate,  and  paralyzed  bladder. 


CARBOLIC  ACID  AND  SULPHO-CAEBOLATES. 

Carbolic  acid  destroys  the  lowest  forms  of  animal  and  vegetable 
life,  and  j)revents  fermentation  and  putrefaction.  While  it  ])revents  the 
fermentation  of  sugar,  it  is  said  not  to  prevent  the  conversion  of  starch 


CARBOLIC     ACID.  257 

into  sugar,  nor  the  decomposition  of  fimygdiilin.  Dr.  Brunfon,  however, 
in  his  work  states  that  strong  solutions  will  prevent  these  changes.  It 
is  largely  employed  to  prevent  tlie  stenches  of  drains,  water-closets,  dis- 
secting rooms,  and  hospital  wards.  Unlike  chlorine  and  permanganate 
of  potash,  carbolic  acid  is  incapable  of  destroying  offensive  gases;  it  only 
prevents  their  formation.  Its  destructive  influence  over  the  low  forms 
of  animal  and  vegetable  life  has  led  to  its  being  employed  as  a  disinfect- 
ant. It  is  a  good  plan  to  hang  a  sheet,  kept  moist  with  a  solution  of 
carbolic  acid,  and  large  enough  to  cover  the  doorway  of  the  sick  cham- 
ber, and  to  extend  a  little  beyond. 

Koch  finds  that  chlorine,  bromine,  and  corrosive  sublimate  are  de- 
cidedly more  efficacious  in  destroying  the  bacilli  spores  of  splenic  fever 
tJian  carbolic  acid,  sulphurous  acid,  or  zinc  chloride ;  and  where  gases  or 
heat  cannot  be  employed  he  recommends  a  mercuric  salt,  as  mercuric 
chloride,  sulphate,  or  nitrate.  One  part  in  a  thousand  of  these  solutions 
killed  the  resting  S2)ores  in  ten  mintues,  and  one  part  in  fifteen  thou- 
sand is  strong  enough  to  kill  micro-organisms. 

Creasote  and  carbolic  acid  act  energetically  on  the  skin,  producing 
opaque,  white  patches,  and  exciting  active  inflammation,  followed,  in  a 
few  days,  by  desquamation.  They  coagulate  albumen,  and  are  stimulant 
and  astringent;  hence  they  may  be  emjjloyed  to  check  bleeding. 

Carbolic  acid,  locally  applied,  is  an  anaesthetic.  Dr.  A.  H.  Smith 
painted  on  his  forearm  a  spot  an  inch  in  diameter,  with  an  85  per  cent, 
solution  of  carbolic  acid.  For  a  minute  it  caused  slight  burning,  then 
the  skin  became  quite  numb,  whitened  and  shrivelled;  at  this  point  he 
made  an  incision  half  an  inch  long  Avithout  even  feeling  the  knife,  the 
wound  healing  as  usual.  Three  hours  afterwards  he  thrust,  without 
pain,  a  needle  into  the  skin,  and  next  he  applied  a  blister  to  the  carbon- 
ized skin  without  causing  pain  or  vesication.  He  found  that  in  incising 
two  whitlows  this  application  greatly  lessened  the  pain. 

Professor  Erasmus  Wilson  employed  carbolic  acid  as  an  anaesthetic, 
to  diminish  the  pain  arising  from  caustics,  as  potassa  fusa.  Brushed 
over  the  delicate  part  or  raw  surface  several  times,  the  acid  coagulates 
the  albumen,  "benumbs  the  surface,  and  iDcrmits  the  caustic  action  with 
a  great  reduction  of  pain."  Mr.  Wilson  employed  this  method  in  lujjus, 
epithelioma,  and  in  disease  of  the  glans  and  prepuce. 

A  solution  of  carbolic  acid  or  glycerine  of  carbolic  acid  is  often  use- 
ful as  a  topical  application  to  relieve  itching;  even  the  itching  due  to 
jaundice.  Dr.  Squibb  says  that  the  anaesthetic  action  is  useful  in  burns 
and  erysipelas,  for  a  one  per  cent,  solution  applied  on  lint  and  frequently 
renewed  relieves  pain  of  burns  in  ten  minutes,  and  its  influence,  pro- 
vided the  application  is  used  from  the  first,  is  persistent  for  twenty -four 
hours. 

Carbolic  acid  applied  as  a  stimulant  and  antisei^tic  to  gangrenous  and 
ill-smelling  sores  prevents  the  stench,  and  improves  the  condition  of  the 
wound. 

Provided  inflammation  runs  not  too  high,  carbolic  acid  ointment, 
composed  of  ten  minims  of  the  acid  to  an  ounce  of  simple  ointment, 
moderates  the  weeping  stage  of  eczema  and  allays  the  tingling  and  itch- 
ing.    It  is  useful  in  the  eczema  of  the  heads  of  children. 

Carbolic  acid  has  the  great  advantage  of  being  free  from  color.     It 
is  useful  in  eczema,  psoriasis,  and  prurigo,  but  it  is  generally  considered 
inferior  to  tar. 
17 


258  CARBOLIC    ACID. 

Dr.  Alder  Smith  finds  glycerine  of  carbolic  acid  very  useful  in  the 
early  stages  of  ringworm. 

Dr.  Eade  recommends  the  use  of  carbolic  acid  for  carbuncles  and 
carbuncular  boils.  He  employs  a  solution  of  one  part  of  carbolic  acid  in 
four  of  glycerine  or  oil,  and  soaks  in  this  small  pieces  of  lint,  and  thrusts 
them  through  the  opening  of  the  broken  skin  to  the  bottom  of  the  holes 
and  sinuses  in  the  carbuncle,  and  keeps  the  surface  of  the  carbuncle  cov- 
ered with  lint  soaked  in  the  solution.  This  application  he  maintains 
prevents  the  extension  of  the  carbuncle.  This  treatment  is  only  useful 
in  that  late  stage  of  the  carbuncle  when  the  skin  is  broken  and  the  car- 
buncle discharging. 

Professor  Iliiter  employs  carbolic  acid  hypodermically  in  erysipelas. 
He  uses  the  following  formula: — Carbolic  acid  and  alcohol,  of  each  3  ss; 
distilled  water,  3  ij.  Of  this  six  to  eight  syringefuls  should  be  in- 
jected at  different  points  where  the  inflammation  is  most  intense,  and 
should  be  repeated  next  day,  or  in  a  few  days,  if  the  disease  spreads. 

Carbolic  acid  topically  applied  is  very  useful  in  malignant  pustule 
(anthrax).  It  may  be  injected  into  the  neighborhood  of  the  pustule; 
two  minims  in  a  two  per  cent,  solution,  repeated  twice  a  day  for  two  or 
three  days,  or  compresses  soaked  in  a  five  per  cent,  solution,  are  to  be 
frequently  a^ipl led.  Some  paint  the  diseased  part  with  concentrated  car- 
bolic acid. 

Glycerine  of  carbolic  acid  appears  to  me  to  be  highly  useful  as  a  topi- 
cal application  in  the  throat  in  diphtheria.  It  should  be  applied  only 
to  the  diseased  portions  of  the  mucous  membrane  twice  a  day. 

Carbolic  acid  sjH'ay  to  the  nose  or  a  gargle  of  one  per  cent,  solution  is 
recommended  in  contagious  coryza  or  sore  throat. 

A  weak  solution  of  carbolic  acid  is  a  very  useful  injection  or  wash  for 
the  cavities  of  large  abscesses,  or  in  empyema,  after  the  evacuation  of 
pus.  A  like  injection  will  correct  the  iVetor  arising  from  cancer  of  the 
womb,  or  other  uterine  diseases.  Carbolic  acid  removes  the  stench  and 
lessens  the  discharge  in  ozsna. 

A  lotion  consisting  of  one  part  of  carbolic  acid  to  one  hundred  parts 
of  water  is  useful  in  pruritus  ani.  Dr.  J.  Thompson  employs  marine  lint 
soaked  in  carbolic  lotion.  He  pushes  every  night  a  small  plug  into  the 
anus,  a  part  being  left  as  a  pad  outside.  Carbolic  acid  is  useful  in  pru- 
ritus pudendi.  It  may  cause  considerable  irritation  both  in  pruritus  ani 
and  pudendi,  the  skin  sometimes  being  so  delicate  that  even  a  weak  aj)- 
plication  causes  considerable  burning  and  smarting. 

The  investigations  of  Dr.  Sansom,  who  first  employed  sulpho-carbo- 
lates  in  medicine,  prove  that  these  salts  arrest  fermentation  in  different 
degrees,  sulpho-carbolate  of  soda  being  most  efficient;  then  follows  a  salt 
of  magnesium,  then  of  potassium,  then  of  ammonium.  Administered 
to  animals,  they  prevent  putrefaction  and  decomjjosition  of  urine,  al- 
though Sansom  could  not  detect  any  of  the  salt  in  this  excretion.  He 
gave  sulpho-carboltite,  and  then  collected  and  preserved  the  urine,  which 
after  six  months  had  not  undergone  decomposition. 

Sulpho-carbolate  of  soda  and  carbolic  acid  are  very  useful  in  flatulence, 
especially  when  there  is  great  distention,  unaccompanied  by  pain,  heart- 
burn, or  other  dyspeptic  symptoms.  Sulpho-carbolate  of  soda  will  gener- 
ally relieve  extreme  flatulence,  producing  copious  eructations  and  con- 
siderable distention,  symptoms  not  unconjmon  in  middle-aged  women 
and  phthisical  patients.     When  flatulence  occurs  immediately  after  a 


CARBOLIC    ACID.  259 

meal  ten  or  fifteen  grains  of  sulpho-carbolate  of  soda  should  be  taken 
just  before  food:  when  it  occurs  some  time  after  meals,  the  medicine  in 
the  same  dose  should  be  taken  half  an  hour  after  food. 

We  often  meet  with  patients,  generally  women,  who  suffer  from  what 
is  ordinarily  called  "spasms."  The  patient  complains  of  considerable 
flatulence  and  distention,  often  limited  to  one  part,  or  sometimes  more 
marked  in  one  part,  of  the  abdomen,  generally  on  the  left  side  under 
the  ribs,  accompanied  by  severe  pain,  which,  like  the  flatulence  itself,  is 
often  most  marked  under  the  left  side  of  the  chest.  The  pain,  tempo- 
rarily relieved  by  the  eructation  of  a  little  wind,  soon  returns  and  may 
endure  many  hours,  and  may  frequently  recur.  In  some  cases  the  com- 
plaint is  evidently  a  neuralgia  of  some  of  the  abdominal  nerves,  the  pain 
being  chiefly  excited  by  flatulence.  Sulpho-carbolates,  in  doses  of  fifteen 
grains,  or  carbolic  acid  in  one  to  two  minim  doses  immediately  before  or 
after  food,  prevent  the  formation  of  wind,  and  they  often  afford  consid- 
erable relief. 

Carbolic  acid  is  readily  absorbed  by  the  skin.  Internally  and  even 
externall}'^,  even  in  small  quantities,  it  may  produce  sometimes  serious 
symptoms,  some  patients  being  affected  much  more  readily  than  others; 
it  may  excite  severe  vomiting,  giddiness,  delirium,  contracted  pupils,  ir- 
regular breathing,  ha^moglobinuria,  even  coma  or  collapse,  with  weak 
pulse  and  cold  sweat,  lowered  temperature,  even  to  several  degrees. 
These  toxic  symptoms  are,  it  is  said,  best  combated  by  the  free  use  of 
diluents;  so,  doubtless,  the  symptoms  arising  from  tar  would  be  bene- 
fited by  the  same  means.  Injected  under  the  skin  of  a  frog,  carbolic 
acid  causes  weakness,  passing  into  complete  paralysis,  convulsions  and 
death.  Slight  irritation  of  the  skin  induces  violent  convulsions.  These 
convulsions  are  central.  Some  believe  they  depend  on  the  action  of  the 
poison  on  the  spinal  cord;  others  conclude  on  experimental  grounds 
that  the  convulsions  are  due  to  the  effect  of  the  poison  on  the  central 
basal  ganglia. 

The  convulsions  are  tetanic  in  frogs,  but  chronic  in  warm-blooded 
animals;  as  with  the  spinal  cord  so  with  the  respiratory  and  vaso-motor 
centre,  they  are  first  stimulated  and  then  paralyzed.  Carbolic  acid 
stimulates  the  sweat  and  salivary  centres. 

Professor  Czerny  describes  a  chronic  carbolic  poisoning  which  attacks 
surgeons  much  exposed  to  the  spray.  There  is  a  slight  headache,  bron- 
chial irritation,  languor,  diminished  appetite.  The  legs  feel  heavy,  there 
is  nausea,  especially  in  the  morning.  The  patient  complains  of  insom- 
nia, and  is  anaemic,  and  his  skin  itches.  These  symptoms  disappear  with 
a  few  days'  absence  from  the  exciting  cause. 

Carbolic  acid  is  recommended  to  reduce  temperature  in  fevers,  but  it 
is  inferior  to  many  other  antipyretics.  Like  other  antipyretics  it  has  a 
greater  effect  on  the  febrile  than  on  the  non-febrile  temperature. 

Carbolic  acid  is  useful  as  a  sedative  to  the  stomach,  and  also  to  check 
fermentation.  Thus,  in  one  to  two  minim  doses  it  is  useful  in  many 
forms  of  vomiting  due  to  irritation  of  the  stomach ;  it  is  likewise  very 
useful  in  flatulence,  especially  when  it  is  copious. 

Carbolic  acid  as  spray  or  administered  internally  is  useful  in  coughs, 
especially  where  the  secretion  is  abundant.  A  four  per  cent,  spray  with 
administration  of  half  a  minim  to  two  minims  every  three  or  four  hours 
is  highly  efficacious  in  whooping-cough. 

Dr.  Lloyd  Eoberts,  of  Manchester,  was  one  of  the  earliest  to  draw  at- 


260  MUSK CASTOREUM. 

tentiou  to  tlie  virtues  of  carbolic  acid,  now  commonly  employed  in  ulcer 
of  the  OS  and  cervix  uteri,  in  chronic  inflammation  of  the  uterus  and 
cervix  with  excoriation,  and  in  chronic  uterine  catarrh.  "  I  use,"  says 
Dr.  Roberts,  "invariably  the  pure  acid.  A  capital  plan  for  maintaining 
the  fluidity  of  the  acid,  devised  by  Mr.  Weir,  of  Dublin,  and  recom- 
mended by  Dr.  Roe,  is  to  add  a  few  grains  of  camphor  to  a  little  of  the 
acid.  In  simple  ulceration  a  free  application  of  the  acid  drawn  over  the 
surface  twice  a  week  is  sufficient.  When  it  is  necessary  to  apply  the 
acid  to  the  interior  of  the  cervical  canal  I  use  a  charged  camel-hair  jien- 
cil,  or  a  gum  elastic  catheter,  having  previously  removed,  with  a  piece  of 
lint  or  injection  of  water,  any  impeding  mucus.  In  applying  it  to  the 
interior  of  the  uterus  by  injection,  it  is  very  important  to  have  the  cer- 
vical canal  freely  open,  so  that  any  superfluous  injection  may  pass  freely 
out.  Care  should  also  be  taken  to  ascertain  the  direction  of  the  uterus; 
as  in  cases  of  retroflexion  any  of  the  injection  passing  beyond  the  curved 
portion  of  the  organ  and  retained  there  Avould  be  certain  to  produce  un- 
toward consequences.  When  injected  into  the  uterine  cavity  the  acid 
should  be  diluted  Avith  glycerine  and  water,  commencing  with  a  weak 
solution,  gradually  increasing  the  strength  as  circumstances  require.  I 
also  use  this  acid  freely  as  an  ordinary  injection  in  vaginal  leucorrhoea,. 
uterine  ulceration,  and  cancer;  and  it  will  be  found  an  excellent  cleanser, 
healer,  disiufector,  and  allayer  of  pain  Although  its  action  does  not 
penetrate  below  the  diseased  surface,  it  possesses,  in  equal  degree  with 
the  stronger  caustics,  the  proj)erty  of  changing  the  vitality  of  the  tissues, 
and  produces  rapid  cicatrization,  dissipates  the  inflammation  and  hyper- 
trophy, and  relieves  pain." 

An  injection  comjjosed  of  twenty  grains  of  sulpho-carl)olate  of  zinc  to 
eight  ounces  of  water,  used  twice  or  thrice  daily,  is  useful  in  gonorrhoea. 

It  is  said  that  sjDonging  the  exposed  part  of  the  body  with  a  weak 
solution  of  carbolic  acid  will  drive  away  mosquitoes. 


MUSK.     CASTOREUM. 

These  medicines,  although  once  highly  esteemed,  especially  musk^ 
by  Graves  and  Cullen,  are  but  seldom  used.  Their  peculiar  and  charac- 
teristic odor  is  o^jpressive  and  sickening,  and  sometimes  causes  headache, 
giddiness,  and  even  fainting ;  hence  musk  is  ill  adapted  for  the  sickroom. 

These  substances  have  a  bitter  taste. 

Jorg  asserts  that  musk,  in  two  to  five-grain  doses,  causes  weight  at 
the  stomach,  eructations,  dryness  of  the  oesophagus,  heaviness  of  the 
head,  giddiness,  headache,  followed  by  sleepiness,  faiutness,  and  a  sensa- 
tion of  heaviness  in  the  whole  body ;  and  in  very  large  doses,  trembling 
of  the  limbs,  and  even  convulsions.  It  is  said  they  strengthen  and 
quicken  the  pulse.  Trousseau  and  Pidoux  failed  to  obtain  these  symp- 
toms, noticing  only  headache  with  giddiness,  the  pulse  being  unaffected. 

These  remedies  are  employed  in  melancholia,  and  for  many  of  those 
anomalous  but  distressing  svm])toms  grouped  under  hysteria.  They 
have  been  given  in  chorea,  epilepsy,  whoo])ii>g-cough,  nervous  palpitation, 
cramps  of  various  parts  of  the  body,  and  even  in  tetanus.     Dr.  Graves 


ALCOHOL.  261 

employed  musk  in  typhus  and  other  fevers,  to  prevent  jjrostration,  and 
to  strengthen  a  weak  and  feeble  pulse. 

Professor  Horatio  "Wood  highly  commends  musk  in  delirium  tremens 
and  acute  specific  fever.  He  gives  ten  grains  with  ten  to  twenty  drops 
of  laudanum  per  anum,  the  laudanum  being  added  to  secure  its  reten- 
tion. He  draws  attention  to  the  fact  that  by  repetition  it  soon  loses  its 
effect. 

In  cardiac  dyspnoea,  ten  drops  of  tincture  of  musk  given  every  quar- 
ter of  an  hour,  for  four  or  six  doses,  is  recommended  to  remove  the  op- 
pression of  breathing  and  to  induce  good  sleep. 


ALCOHOL. 


FoK  many  reasons  alcohol  might  be  grouped  conveniently  with  chloro- 
form and  ether,  there  being  much  similarity  in  the  action  of  these  three 
medicines.  Each,  at  first,  produces  much  excitement,  with  increased 
strength  of  the  pulse,  tbis  stage  after  a  time  giving  way  to  another  of  uncon- 
sciousness, Avhich  may  be  profound;  but  with  this  general  similarity  there 
is  an  important  difference  between  alcohol  on  the  one  hand  and  chloro- 
form and  ether  on  the  other.  With  chloroform  and  ether  the  stage  of 
excitement  is  brief,  soon  passing  into  that  of  insensibility,  which  may 
endure  a  long  time  without  danger  to  life.  But  with  alcohol  the  early 
stage  of  excitement  and  intoxication  is  of  considerable  duration,  insensi- 
bility and  unconsciousness  not  coming  on  till  large  quantities  have  been 
taken,  and  some  time  has  passed.  In  this  stage  of  insensibility  the 
danger  of  death  is  imminent  from  paralysis  of  the  heart  and  of  the  move- 
ments of  respiration.  It  will  be  easily  understood,  therefore,  that  while 
chloroform  and  ether  are  used  as  ana?sthetics  alcohol  is  inadmissible  for 
this  purpose. 

Alcohol,  owing  to  its  volatility,  is  sometimes  employed  to  abstract  heat, 
and  cool  the  surface  of  the  body,  as  in  inflammation  of  the  brain,  etc., 
but  it  is  not  a  very  effectual  refrigerator,  and  ice  is  preferable. 

If  its  evaporation  is  prevented,  it  penetrates  the  skin,  owing  to  its 
tolerably  high  diffusion-power  and  excites  the  tissues  beneath  the  cuticle, 
causing  a  sensation  of  heat  and  some  inflammation.  It  may  be  thus  em- 
ployed as  a  counter-irritant. 

It  coagulates  albumen,  and  is  sometimes  used  to  cover  sores  with  a 
thin,  protective,  air-excluding  layer,  which  promotes  the  healing  process. 
Alcohol,  in  the  form  of  brandy  or  eau  de  Cologne,  is  often  applied  to 
harden  the  skin  of  parts  exposed  to  pressure,  and  to  obviate  the  occur- 
rence of  bed-sores,  an  excellent  practice,  which  should  be  adopted  before 
the  occurrence  of  abrasion,  or  even  before  redness  occurs.  It  is  a 
useful  practice  to  bathe  the  nipple  with  brandy,  each  time  after  a  suck- 
ling, then  carefully  to  wash  the  part,  and  dab  it  dry.  It  is  well  to  apply 
the  brandy  some  days  before  delivery,  so  as  to  harden  the  tissues,  and 
prevent  the  formation  of  cracked  nipples,  which  give  rise  to  so  much 
pain  and  distress. 

In  virtue,  probably,  of  its  power  to  coagulate  albumen,  and  perhaps 
of  other  properties,  it  constringes,  to  a  small  extent,  the  mucous  mem- 


262  ALCOHOL. 

branes  of  the  month,  and  is  sometimes  nsed,  dilnted  with  water,  as  an 
astringent  gargle  in  relaxed  throat,  scnrvy,  salivation,  etc. 

In  the  stomach  it  exerts  a  double  action.  Thus  it  may  affect  both  the 
gastric  juice  and  the  secreting  mucous  membrane.  Its  action  in  these 
respects  will  be  considered  separately.  The  effect  of  a  small  quantity  of 
alcohdl  on  the  pepsine  of  the  gastric  juice  is  insignificant;  but  a  large 
quantity  precipitates  the  pepsine,  but  adding  water  redissolves  it. 

As  with  the  gastric  juice  so  with  the  mucous  membrane,  the  topical 
effect  of  alcohol  differs  according  to  whether  the  dose  is  large  or  small. 
It  has  been  experimentally  proved  that,  taken  very  moderately,  it  in- 
creases the  secretion  of  the  gastric  juice,  and  every  day  experience  con- 
firms this  fact;  whilst  undue  quantities  destroy  the  appetite,  upset  the 
stomach,  inflame  its  mucous  coats,  cover  it  with  a  thick  tenacious  mucus, 
and  abolish  its  secreting  power. 

Owing  to  this  influence  on  the  functions  of  the  stomach  alcohol  is  a 
remedial  agent,  as  the  following  examples  will  illustrate: 

I.  Some  persons,  after  undergoing  considerable  fatigue,  are  apt  to  lose 
all  appetite  and  digestive  power,  and  on  taking  food  to  suffer  from  an  un- 
digested load  on  the  stomach;  but  a  glass  of  wine  or  a  little  brandy -and- 
water,  taken  shortly  before  food,  will  restore  appetite  and  digestion. 

II.  In  the  convalescence  from  acute  diseases,  when  digestion  and 
strength  may  remain  a  long  time  depressed,  alcoholic  stimulants,  taken 
just  before  or  at  meal -times,  are  often  serviceable. 

III.  Many  dwellers  in  towns,  who  lead  a  sedentary  life,  and  suffer 
often  from  weak  digestion,  find  that  only  by  the  help  of  alcohol  in  some 
form  can  they  properly  digest  their  food. 

IV.  Stimulants  are  most  serviceable  in  the  prostration  from  aciite 
illness,  when,  in  common  Avitli  the  other  functions,  digestion  is  much  de- 
pressed, at  a  time  when  it  is  most  important  to  support  the  strength  until 
the  disease  has  done  its  worst.  Strength,  no  doubt,  is  best  supported  by 
food;  yet  the  weakened  stomach  can  digest  but  sparingly;  but  at  this 
critical  juncture  alcohol  spurs  the  flagging  digestion,  and  enables  the 
patient  to  take  and  assimilate  more  food. 

Next,  the  time  of  giving  the  alcoholic  stimulant  is  a  matter  of  great 
importance.  It  should  not  be  given  at  haphazard,  as  is  too  commonly 
the  case,  but  should  be  given  with  the  food.  To  a  patient  laboring  under 
great  prostration,  in  whom  digestion  is  very  feeble,  food  and  stimulants 
should  be  given  together,  in  small  quantities,  frequently  repeated;  but  a 
strong  patient  had  better  take  food  at  the  ordinary  meal-times,  when, 
from  habit,  the  stomach  digests  better. 

It  is  necessary  to  insist  on  this  point,  as  it  is  common  with  both  doc- 
tors and  patients  to  trust  to  alcohol  alone,  forgetting  that  while  it  bene- 
fits by  stimulating  the  heart,  it  at  the  same  time  effectually  aids  the 
digestive  process,  and  thus  supports  the  patient  in  the  best  and  most 
natural  manner. 

It  has  been  mentioned  that  large  quantities  of  alcohol  excite  catarrh 
of  the  stomach,  but  it  is  singular  how  large  a  quantity  a  patient  pros- 
trated by  fever  can  take  without  producing  this  result.  The  same  fact 
may  be  noticed  in  convalescence  from  exhausting  diseases.  Still,  care 
must  be  exercised,  since  stimulants,  if  too  freely  given,  will  sometimes 
upset  the  stomach,  so  that  the  food  is  vomited,  an  untoward  circumstance 
gi'eatly  adding  to  the  patient's  danger. 

After  a  variably  time  the  prolonged  indulgence  in  alcoholic  drinks 


ALCOHOL.  263 

seriously  damages  the  stomach  by  producing  chronic  catarrh.  The 
mucous  membrane,  coated  with  tenacious  mucus,  excites  unhealthy  fer- 
mentation of  the  food,  while  the  structure  of  the  membrane  itself 
undergoes  considerable  alteration,  through  great  increase  of  the  connec- 
tive tissue,  which  by  its  contraction  obstructs  and  destroys  the  secreting 
follicles  and  their  lining  cells.  The  mucous  membrane  thus  becomes 
thickened,  hardened,  and  uneven;  and,  owing  to  obliteration  of  the  ori- 
fices of  the  follicles,  cysts  form  in  its  substance,  and  these  enlarge  from 
the  accumulation  of  cells  within  them.  In  consequence  of  these  serious 
changes  little  gastric  juice  is  j^oured  out  in  response  to  the  demand  made 
by  the  food,  while  the  unhealthy  mucous  coating  of  the  stomach,  by 
exciting  morbid  fermentations,  induces  the  production  of  much  gas,  with 
various  acids,  as  butyric,  acetic,  etc.,  whence  acidity  and  heartburn. 
Morning  vomiting  of  a  scanty,  sour,  bitter,  and  tenacious  fluid  is  a  char- 
acteristic symptom  of  this  condition.  Owing  to  its  high  ditfusion-power, 
alcohol  passes  readily  into  the  blood,  so  that  but  little  can  reach  far  into 
the  intestines.  Spirits,  especially  brandy,  are  often  successfully  employed 
after  the  removal  of  the  exciting  irritant,  to  control  the  after  stages  of 
acute  simple  diarrhoea,  when  the  relaxed  condition  of  the  mucous  mem- 
brane allows  the  liquid  parts  of  the  blood  to  pass  into  the  intestines,  pro- 
ducing frequent  watery  stools.  In  the  vomiting  and  diarrhoea  of  children 
small  doses  of  brandy,  added  to  food,  are  very  useful.  Brandy  often  in- 
duces refreshing  sleep  in  children.  Even  in  large  quantities  alcohol  ap- 
pears neither  to  promote  nor  to  hinder  the  conversion  of  starch  into  sugar. 

01)servations  on  the  influence  of  alcohol  on  the  blood  and  organs,  have 
yielded  contradictory  results,  the  most  recent  and  elaborate  investigations 
of  Drs.  Parkes  and  Wollowicz  clashing  in  most  ^particulars  with  those  of 
previous  experimenters.  Hitherto  it  was  held  that  alcohol  diminishes 
the  oxidation  of  the  body,  but  Parkes  and  Wollowicz's  observations  are 
opposed  to  this  conclusion.  Dr.  G.  Harley  found  that  alcohol  in  small 
quantities  added  to  blood  withdrawn  from  the  body,  lessened  its  absorp- 
tion of  oxygen  and  its  elimination  of  carbonic  acid. 

As  the  result  of  a  great  many  observations  taken  in  conjunction  with 
Dr.  Rickards,  every  quarter  of  an  hour,  for  several  hours,  on  persons  of 
all  ages,  we  found  that  alcohol,  brandy,  and  wine,  diminish  the  body 
temperature.  After  moderate  doses  the  fall  was  slight,  amounting  to 
not  more  than  0.4"  to  0.6°  Fall.,  but  after  poisonous  doses  the  depression 
in  one  instance  reached  nearly  three  degrees;  in  rabbits  the  fall  was  much 
greater,  reaching  to  ten  or  more  degrees.  These  observations  have  been 
confirmed  by  Professor  Binz,  of  Bonn,  and  by  Dr.  Eichardson,  who  asserts 
that  all  alcohols  redaice  the  animal  temperature.  Drs.  Parkes  and  Wol- 
lowicz, whose  observations  are  opposed  to  the  foregoing,  gave  to  a  healthy 
young  man,  in  divided  quantities,  for  six  days,  a  daily  amount  of  absolute 
alcohol,  varying  from  one  to  eight  ounces,  and,  on  a  subsequent  occasion, 
twelve  ounces  of  brandy  daily  for  three  days,  observing  meanwhile  the 
temperature  of  the  body  every  two  hours.  The  average  temperature  of 
the  alcohol  and  of  the  brandy -drinking  days,  was  found  to  be  almost  iden- 
tical with  that  on  days  when  only  water  was  taken.  These  conflicting 
results  it  is  difficult  to  reconcile;  but  it  must  be  granted  that  a  consid- 
erable quantity  of  alcohol,  repeated  several  times  a  day,  does  not  perma- 
nently reduce  the  body  temperature.  Dr.  Parkes  has  recently  re-investi- 
gated this  question,  and  he  finds  that  dietetic  doses  (two  fiuid  ounces  of 
absolute  alcohol)  given  to  a  healthy  fasting  man  at  rest  often  reduces  the 


1 


264  ALCOHOL. 

rectal  temperature  rather  less  than  half  a  degree;  hut  when  the  alcohol 
is  given  with  food,  even  in  doses  of  four  to  eight  ounces  of  absolute  alco- 
hol, it  produces  no  effect  on  the  temperature.  In  a  boy  aged  ten.  who 
had  never  in  his  life  before  taken  alcohol  in  any  form,  I  found  through  a 
large  number  of  observations  a  constant  and  decided  reduction  of  tem- 
perature. It  is  possible  that  alcohol  given  in  repeated  doses  may  soon 
lose  its  power  of  depressing  the  temperature.  Excessive  habitual  indul- 
gence appears  to  have  this  effect;  for  Dr.  Rickards  and  I  gave  to  an 
habitual  drunkard,  making  him  "  dead  drunk,"  twelve  ounces  of  good 
brandy  in  a  single  dose,  without  the  smallest  reduction  of  the  tempera- 
ture. The  effect  on  the  body  temperature  was  formerly  ascribed  partly 
to  the  increased  loss  of  heat  through  the  skin  by  dilatation  of  the  blood- 
vessels, and  in  a  lesser  degree  from  diminished  oxidation  and  lessened  pro- 
duction of  heat;  but  Dr.  B.  Lewis  and  Drs.  Wood  and  Reichert  find  that 
alcohol  increases  both  heat  production  and  heat  dissipation,  but  whether 
the  increased  loss  leads  to  the  increased  production,  or  vice  vernd,  they  are 
unable  to  decide.  The  time  of  greatest  heat  production  coincides  with 
the  lowest  bodily  temperature ;  which  suggests  that  increased  loss  leads 
to  increased  formation  of  heat.  This  increased  production  of  heat  proves 
that  alcohol  does  not  influence  temperature  by  lessening  oxidation. 

In  their  experiments  on  the  urine  Bocker  and  Hammond  found  that 
*'  the  formation  of  urea,  of  the  extractives,  and  of  sulphuric  acid  and 
phosphoric  acid,  Avas  lessened  by  alcohol  and  beer,  and  the  water  and  free 
acidity  of  the  urine  was  diminished ; "  but  in  Parkes'  and  Wollowicz's  ob- 
servations, alcohol,  brandy,  and  claret  produced  no  decreased  elimination 
by  urine  of  the  urea,  phosphoric  acid,  or  free  acidity.  They,  however, 
increased  the  amount  of  urinary  water. 

Edward  Smith  found  that  brandy  and  gin  diminish,  while  rum  in- 
creases, the  pulmonary  carbonic  acid.  These  conflicting  statements  it  is 
impossible  to  reconcile;  but  Parkes'  observations  were  so  carefully  con- 
ducted, and  are  so  complete,  that  they  must  be  accepted  as  authoritative. 

How  much  alcohol  is  consumed  in  the  Ijody  ?  The  results  of  investi- 
gations to  determine  this  point  are  so  contradictory  that  it  is  impossible 
to  decide  the  value  of  alcohol  as  a  food.  Bouchardat,  Sandras,  and 
Duchek  conclude  that  alcohol  is  freely  consumed  in  the  body,  little  escap- 
ing by  the  urine,  iinless  very  large  quantities  are  taken.  On  the  o'ther 
hand,  Perrin,  Duroy,  and  Lallemand  deny  that  alcohol  is  consumed 
in  the  smallest  degree  in  the  body.  Anstie  concludes  from  careful  ex- 
periments that  the  greater  part  of  the  alcohol  is  consumed,  and  he  has 
undoubtedly  proved  that  only  a  little  escapes  with  the  urine,  while  Parkes 
and  Wollowicz  believe  that  a  considerable  quantity  escapes  with  the  sweat 
and  breath.  Dupre's  recent  observations  confirm  those  of  Anstie,  prov- 
ing that  only  a  fractional  part  of  alcohol  escapes  from  the  body;  and 
Anstie  believes  that  this  never  occurs  except  with  a  narcotic  dose,  which 
varies  in  different  persons. 

Even  if  the  greater  part  of  alcohol  is  consumed,  and  thi;s  ministers  to 
the  forces  peculiar  to  the  body,  yet  alcohol,  by  depressing  functional 
activity,  favoring  degeneration,  etc.,  may  do  more  harm  than  can  be 
counterbalanced  by  any  good  it  may  effect  by  the  force  it  sets  free  dur- 
ing its  destruction;  even  if  taken  in  quantities  too  small  to  do  harm,  yet 
it  can  scarcely  be  classed  as  an  economical  food  for  the  healthy.  Granted 
that  dietetic  doses  check  oxidation  in  the  healthy,  and  thus  economize 
the  blood  and  tissues,  still,  unless  it  can  be  shown  that  in  health  there  is 
constantly  an  excess  of  consumption  over  and  above  that  required  by  the 


ALCOHOL.  265 

body,  such  a  diminution  of  oxidation  could  only  result  in  lessening  the 
amount  of  force  set  free  and  put  at  the  disposal  of  the  organs,  entailing 
of  course  a  diminution  of  the  functional  activity  of  the  body.  Physiology 
failing  to  guide  our  steps  amid  these  conflicting  statements,  it  is  obvious 
that  in  estimating  the  value  of  alcohol  in  health  or  disease  we  must  rely 
solely  on  experience,  which  plainly  shows,  that,  for  the  healthy,  alcohol 
is  not  a  necessary  nor  even  a  useful  article  of  diet.  Varied,  repeated,  and 
prolonged  experience,  and  the  testimony  of  army  medical  men,  prove 
that  troops  endure  fatigue  and  the  extremes  of  climate  better  if  alcohol 
is  altogether  abstained  from.  The  experience  of  the  celebrated  Moscow 
campaign  showed  this ;  and,  a  few  years  ago,  the  Red  Eiver  expedition. 
During  arduous  marches  it  has  always  been  found  that,  without  alcoliol, 
the  health  of  the  men  is  exceptionally  good,  but  as  soon  as  spirits  are 
allowed  disease  breaks  out.  Modern  trainers  recognize  the  fact  that  the 
power  of  sustained  exertion  and  resistance  to  fatigue  is  best  promoted  by 
abstaining  from  alcohol,  and  the  ill-health  of  many  athletes  depends, 
not  on  the  rigor  of  the  training,  but  on  the  excesses  they  indulge  in  after 
the  contest. 

There  can  be  no  doubt  that  healthy  persons,  capable  of  the  fullest 
amount  of  mental  and  physical  exertion  Avithout  the  stimulus  of  alcohol, 
not  only  do  not  require  it,  but  are  far  better  without  it. 

It  must  be  recollected,  however,  that  these  remarks  apply  to  pure 
alcoholic  drinks,  as  spirits,  and  not  to  beers  and  wines,  which  contain  in- 
gredients useful  as  food.  The  amount  of  alcohol  in  the  lighter  beers 
and  wines  is  small,  and  can  hardly  be  prejudicial  to  the  robust,  while 
they  seem  to  brace  up  and  sustain  the  flagging  functions  of  the  weakly, 
as  town-dwellers,  especially  those  who  pass  mucli  of  their  time  indoors, 
in  an  unhealthy  atmosphere.  Some,  indeed,  cannot  properly  digest  food 
without  a  stimulant. 

Dr.  Anstie  highly  extolled  alcoholic  stimulants  in  the  debility  of  old 
age,  especially  in  the  "  condition  of  sleeplessness,  attended  often  with 
slow  and  ineffectual  digestion  and  a  tendency  to  stomach  cramps."  He 
employs  "a  generous  and  potent  wine,"  containing  much  ether. 

Alcoholic  drinks,  especially  those  containing  a  large  quantity  of  vola- 
tile ether,  often  relieve  the  pain  of  neuralgia,  the  alcohol  removing  the 
temporary  nervous  depression  which  produces  the  paroxysm;  alcohol  for 
a  time  relieves  the  distressing  symjjtoms  occurring  in  so-called  hysteria, 
generally  met  with  in  middle-aged  Avomen;  but,  as  the  stimulant  after  a 
time  must  be  taken  in  increasing  quantities,  there  is  great  danger  lest  the 
patient  should  acquire  the  habit  of  taking  alcohol  to  excess.  Nervous  or 
neuralgic  patients  are  often  prone  to  imbibe  alcohol  in  excess,  and  thus 
many  women  become  confirmed  tipplers.  It  behoves  the  doctor  then  to 
be  very  guarded  and  precise  in  prescribing  alcoholic  stimulants. 

AVhatever  doubt  may  exist  concerning  the  usefulness  of  alcohol  in 
moderate  quantities,  there  can  be  no  question  of  its  pernicious  and 
poisonous  effects  when  taken  in  excess.  It  then  injures  and  degenerates 
the  tissues  of  all  parts  of  the  body  and  produces  premature  old  age,  for  it 
produces  increase  of  the  connective  tissue  (fibrosis)  and  fatty  degeneration 
of  parenchymatous  tissues  (steatosis).  The  lungs  become  prone  to  em- 
physema; there  is  diminution  of  both  physical  and  mental  vigor;  the 
kidneys,  liver,  and  stomach  may  become  cirrhosed.  Even  in  a  state  of 
so-called  health,  when  the  effects  of  hard-drinking  are  not  very  apparent, 
they  become  at  once  evident  on  the  occurrence  of  illness  or  accident,  when 


266  ALCoiioi.. 

tlie  constitution  manifests  its  undermined  condition  and  its  diminished 
power  to  resist  disease.  Thus  drunkards  succumb  to  accident  or  illness 
which  temperate  men  easily  pass  through. 

Delirium  tremens  may  arise  in  different  ways;  sometimes  through  a 
single  debauch,  Imt  commonly  it  attacks  those  who  habitually  take  an 
excessive  quantity  of  wine  or  spirits,  without  perhaps  ever  getting  drunk. 
In  an  attack  arising  from  an  exceptional  debauch  it  is  merely  necessary  to 
withhold  spirituous  drinks  for  a  time,  to  allow  the  system  to  get  rid  of  the 
alcohol.  On  the  other  hand,  delirium  tremens  is  often  excited  in  habitual 
topers  by  altogether  withholding  intoxicating  drinks,  so  that  in  treating 
these  chronic  drinkers  a  moderate  quantity  of  some  alcoholic  drink  for  a 
time  must  generally  be  allowed.  It  is  right,  however,  to  add  that  many 
excellent  ooservers  contend  that  it  is  wiser  to  cut  off  alcohol  altogether, 
maintaining  that  the  symptoms  are  due  to  the  paralyzing  action  of  alcohol 
on  the  nerve  centres. 

The  influence  of  alcohol  on  the  heart  is  most  noteworthy.  It 
strengthens  the  contractions  of  the  heart,  especially  when  this  organ  is 
weakened  by  debilitating  diseases,  which  are  always  attended  by  a 
quickened  and  weakened  pulse.  In  health,  alcohol  dilates  the  arterioles  and 
makes  the  pulse  larger  and  softer;  in  disease,  or  when  from  other  causes 
the  arterioles  are  relaxed,  it  contracts  them,  rendering  the  pulse  smaller, 
slower,  less  frequent,  and  more  resistant;  alcohol  strengthens  the  pulse, 
and  reduces  its  frequency  and  must  be  considered  one  of  the  most  powerful 
cardiac  tonics.  This  tonic  property,  combined  with  its  influence  in  pro- 
moting digestion  by  increasing  the  gastric  juice,  explains  the  great  use- 
fulness of  alcoholic  beverages  in  debilitating  chronic  and  acute  diseases. 

In  most  diseases  accompanied  by  weakness  or  prostration  alcohol  in 
one  or  other  form  often  proves  a  valuable  remedy.  It  is  of  conspicuous 
service  in  acute  diseases  running  a  limited  and  definite  course,  in  the 
treatment  of  Avhich  the  cardinal  point  is  to  sustain  the  vital  force  beyond 
the  critical  stage. 

Brandy  or  wine  are  the  best  remedies  when  the  heart  is  suddenly  en- 
feebled, from  fright,  loss  of  blood,  accidents,  or  other  causes." 

Great  as  are  the  beneficial  effects  of  alcohol  in  disease  yet  it  may  do 
harm  as  well  as  good.  Certain  precautions  must  therefore  be  observed, 
and  its  effects  on  the  functions  must  be  carefully  watched.  Althougli 
the  heart  affords  the  most  trustworthy  information  on  this  }ioint,  yet  the 
influence  of  alcohol  on  the  other  organs  must  not  be  overlooked,  as  it 
may  happen  that  wdiile  alcohol  may  benefit  one  part  of  the  system  it  may 
injure  another,  doing  good  in  one  respect,  yet  on  the  whole  inflicting 
more  harm. 

The  following  rules  regarding  the  use  of  stimulants  in  fever  were  laid 
down  by  Dr.  Armstrong,  endorsed  by  Dr.  Graves,  and  will  receive  the 
assent  of  all  practical  men:— 

1.  If  the  tongue  become  more  dry  and  baked,  alcoholic  stimulants 
generally  do  harm;  if  it  become  moist,  they  do  good. 

2.  If  the  pulse  become  quicker,  they  do  harm;  if  it  become  slower, 
they  do  good. 

3.  If  the  skin  become  hot  and  parched,  they  do  harm;  if  it  become 
more  comfortably  moist,  they  do  good. 

'  In  threatened  fainting,  it  is  a  good  plan  to  direct  the  patient,  whilst  sitting  down 
to  lean  forward  and  jilace  the  head  between  the  legs  as  Ioav  down  as  possible,  so  that 
the  blood  may  gravitate  to  the  brain. 


1 


ALCOHOL.  267 

4.  If  the  breathing  become  more  hurried,  they  do  harm;  if  it  become 
more  and  more  tranquil,  they  do  good. 

These  excellent  rules  might  be  supplemented  by  a  fifth;  alcohol  does 
good  Avlien  it  produces  sleei?,  and  quells  delirium.     (See  Opium.) 

In  judging  of  the  influence  of  alcohol  on  the  pulse,  its  compressibility 
is  of  more  importance  than  its  volume.  Under  the  action  of  alcohol  a 
soft  and  yielding  pulse  of  large  volume  often  becomes  much  smaller  and 
less  compressible,  changes  indicating  an  increase  in  the  tonicity  of  the 
arteries,  and  in  the  strength  of  the  heart. 

Such  are  the  rules  which  must  guide  us  in  the  employment  of  alcohol 
in  disease,  giving  us  data  as  to  the  quantity  we  should  administer,  and 
whether  we  should  continue,  increase,  or  withhold  it. 

There  are  other  circumstances  which  we  must  carefully  regard  in 
respect  to  the  employment  of  alcoholic  drinks.  At  the  two  extremes  of 
age,  the  powers  of  the  body  being  easily  depressed,  stimulants  are  accord- 
ingly called  for  early,  and  must  be  freely  used.  In  the  aged,  especially, 
it  is  of  great  importance  to  anticipate  prostration  by  the  early  employment 
of  alcohol;  for  it  is  very  difficult  to  overcome  this  condition.  Young 
children  prostrate  from  disease  take  stimulants  with  benefit,  eveii  in  large 
quantities.  Xext,  the  knowledge  of  the  course  a  disease  ordinarily  runs 
gives  us  timely  indications  in  respect  of  this  question.  In  some  acute 
diseases,  as  typhus,  in  which  the  depression  is  often  very  marked,  es- 
pecially at  the  extremes  of  life,  stimulants  should  be  employed  early. 

Alcohol  is  sometimes  given  to  fever  patients  in  very  large  quantities. 
It  is  given  to  reduce  fever,  and  to  check  waste.  In  fevers,  no  doubt, 
there  is  greatly  increased  destruction  of  the  nitrogenous  tissues,  shown 
by  the  large  quantity  of  urea  eliminated  by  the  urine;  at  the  same  time, 
all  the  functions  of  the  body  are  much  depressed,  and  can  appropriate 
less  of  the  force  set  free  by  oxidation  than  in  health.  From  these  two 
causes,  and  partly  likewise  from  diminution  of  perspiration,  so  that  the 
heat  fails  to  pass  off  duly  by  the  skin,  jareternatural  temperature  of  the 
body  occurs  in  fevers.  Alcohol  in  large  doses,  it  is  maintained,  lessens 
oxidation  and  prevents  Avaste,  and  thereby  lowers  the  temperature  of  the 
body,  and  diminishes  the  amount  of  urea  in  the  urine;  but  to  effect  this 
very  large  doses  must  be  given — doses  which,  in  some  cases  at  least,  I 
should  imagine  might  do  harm  in  other  ways ;  hence,  the  influence  on 
the  pulse,  respiration,  etc.,  according  to  the  rules  just  laid  down,  must 
be  very  carefully  watched. 

Several  years  ago  I  made  a  large  number  of  observations  concerning 
the  influence  of  alcohol  on  the  temperature  of  fever,  and  found  that  as 
in  health,  so  in  fevers,  alcohol  slightly  reduces  the  temperature;  but  its 
efficacy  in  this  respect  is  so  insignificant,  and  doses  so  enormous  must  be 
taken  to  produce  even  trifling  results,  that  it  is  useless  to  give  alcohol 
solely  with  this  intention. 

In  my  judgment,  there  can  be  210  doubt  that  alcohol  is  not  required 
in  all  febrile  diseases ;  on  the  contrary,  many  cases  are  best  treated  Avith- 
out  it.  Children  and  young  persons  previously  healthy  rarely  require  it, 
and  in  no  instance  should  it  be  given  unless  special  indications  arise. 
The  enormous  quantities  of  alcohol  which  used  to  be  given  a  short  time 
ago,  and  are  indeed  now  sometimes  administered,  are,  I  believe,  rarely 
needed,  although  very  large  doses  are  occasionally  needed,  and  are  un- 
doubtedly the  means  of  saving  life. 

The  kind  of  alcoholic  stimulant  employed  is  perhaps  not  a  matter  of 


268  ALCOHOL. 

great  importance,  provided  its  quality  is  good.  It  is  undesirable  to  give 
several  kinds  of  stimulants  at  about  the  same  time,  or  they  may  derange 
the  stomach;  but  they  may  be  changed  from  time  to  time  according  to 
the  jiatient's  desire.  Anstie  recommends  strong  alcoholic  drinks  in  fevers, 
as  brandy,  in  the  earlier  and  middle  stages;  but  when  the  heart  flags,  and 
the  nervous  system  becomes  weakened,  he  prefers  wines  containing  plenty 
of  compound  ethers.  Stimulants  should  not  be  given  in  large  quantities 
to  weakly  persons  at  distant  intervals  of  the  day;  it  is  far  better  to  give 
them  in  small  and  frequent  doses.  A  large  dose  at  one  time  strongly 
stimulates  the  heart;  then,  as  the  alcohol  is  decomposed  or  eliminated, 
the  heart  is  left  unsustained,  when  great  weakness  may  set  in;  whereas, 
the  frequent  administration  of  smaller  quantities  keeps  the  heart  more 
uniformly  supported. 

Some  easily  digested  food  in  small  quantities  should  be  given  with  the 
stimulant,  which,  by  promoting  digestion,  supports  the  patient's  strength 
in  the  most  natural  and  most  effectual  way.  As  a  rule,  when  food  is 
freely  taken  and  digested,  stimulants  are  little  needed. 

Weakly  children  derive  more  benefit  by  taking  stimulants  about  an 
hour  before,  rather  than  with  food,  which  plan  enables  them  to  take  more 
food,  and  to  digest  it  better,  than  the  more  common  one  of  giving  the 
stimulant  Avith  food. 

In  common  with  ether  and  chloroform,  alcohol  is  an  antispasmodic, 
but  in  this  respect  ether  and  chloroform  are  more  effective. 

It  does  sometimes  happen  that  one  alcoholic  stimulant  is  harmful, 
while  another  is  found  useful;  a  fact  especially  noticeable  in  coughs, 
which  are  aggravated  by  porter  or  beer,  but  are  unaffected  or  even  re- 
lieved by  brandy  or  Avine.  Beer  or  stout  sometimes  produces  sleepiness, 
heaviness,  even  headache,  and  flushing  of  the  face,  while  the  same  person 
can  take  wine  or  brandy  without  inconvenience.  Individual  peculiarities 
abound  in  respect  of  wines;  for  example,  one  person  cannot  take  sherry 
without  suffering  from  acidity,  Avhile  another,  on  taking  port,  is  seized 
with  gouty  pains. 

The  wish  of  the  patient  for  any  particular  form  of  stimulant  is  often  a 
correct  indication  of  its  desirability.  A  free  draught  of  the  weaker  beers 
will  often  gratefully  slake  the  urgent  thirst  of  fever. 

Stout  is  supporting  and  nourishing  to  persons  brought  low  by  ex- 
hausting discharges,  and  to  women  weakened  by  suckling,  though  in 
many  cases  unfortunately  it  disagrees,  producing  headache  and  sleepiness. 
The  good  old-fashioned  remedy,  rum  or  brandy  and  milk  taken  before 
breakfast,  is  useful  in  phthisis  and  in  exhausting  diseases.  A  little  rum 
and  milk  an  hour  before  rising  is  a  good  prop  to  town-living  women,  to 
whom  dressing  is  a  great  fatigue,  who,  without  appetite  for  breakfast, 
suffer  from  morning  languor  and  exhaustion,  often  lasting  till  mid-day, 
and  to  couA^alescents  from  acute  diseases. 

The  ill-effects  of  alcohol  in  gonorrhoea  are  well  known.  A  cure  is 
much  more  readily  effected  if  the  patient  Avill  abstain  altogether  from 
alcoholic  beverages.  Even  Avlien  the  cure  seems  near  completion  a  single 
indulgence  in  spirits,  wine  or  beer,  will  bring  back  the  scalding  and  dis- 
charge. 

In  some  persons,  alcohol,  unless  in  a  very  dilute  form,  and  in  very 
moderate  doses,  quickly  affects  piles.  Beer,  champagne,  port,  strong 
claret,  even  in  a  few  minutes  cause  burning  pain  and  aching  in  the 
rectum,  lasting  for  hours.  With  some  persons  coffee  or  pepper  act  in  the 
same  rapid  way. 


CHLOROFORM.  269 


CHLOROFOEM. 

Chlopofokm,  when  applied  to  the  surface  of  the  body,  speedily  vola- 
tilizes and  cools  the  skin;  but  it  is  seldom  used  as  a  refrigerator,  being  in 
this  respect  inferior  to  other  agents. 

Owing  to  its  high  dilfusion-power  chloroform  readily  penetrates  the 
animal  textures.  If  evaporation  is  prevented,  it  penetrates  the  cuticle 
and  excites  inflaramation,  and  thus  becomes  a  rubefacient. 

In  quantity  insufficient  to  excite  inflammation,  chloroform  deadens 
sensation,  and  acts  as  a  local  anaesthetic.  It  is  sometimes  applied  to  relieve 
pain,  and  occasionally  with  good  effect,  although  it  often  fails,  and  is 
inferior  for  this  purpose  to  many  other  external  applications.  It  has 
been  used  in  neuralgias,  sometimes  effectively,  but  it  generally  fails,  and 
even  when  successful,  the  relief  is  ordinarily  very  temporary,  the  pain  soon 
returning. 

In  faceache  or  toothache,  two  or  three  drops,  on  a  small  piece  of  cotton- 
wool, introduced  into  the  ear,  give  occasionally  complete  and  permianent 
relief;  but  if  too  large  a  quantity  is  used  it  Avill  excite  inflammation,  even 
vesication,  and  give  much  annoyance.  The  pain  of  cancer,  when  the 
skin  is  broken,  leaving  a  painful,  irritaljle  sore,  is  relieved  by  playing 
vapor  of  chloroform  on  the  raAv  surface,  and  often  the  immunity  from 
pain  lasts  several  hours;  a  like  proceeding  relieves  the  pain  of  cancer  of 
the  uterus,  of  ulceration  of  the  os  uteri,  of  neuralgia  of  the  uterus,  and, 
in  a  less  degree,  the  annoyance  of  pruritus  pudendi.  The  vapor  must  be 
made  to  play  on  the  os  uteri  for  some  minutes.  I  think  that  chloroform 
vapor  might  be  useful  in  cancer  of  the  rectum,  spasm  of  the  intestines, 
etc. ,  re-collecting,  however,  that  chloroform  is  easily  absorbed  b}''  the  large 
intestine. 

According  to  Sir  J.  Simpson,  a  few  drops  of  chloroform  whilst  evapo- 
rating from  the  palm  of  the  hand  held  close  to  a  photophobic  eye  will 
enable  it  to  bear  the  light  without  pain. 

Dr.  Churchill  lessens  the  violence  of  the  paroxysms  of  whooping-cough 
by  the  simple  plan  of  directing  the  nurse  to  pour  about  half  a  drachm  of 
ether  or  chloroform  over  her  hand,  and  to  hold  it  before  the  child's 
mouth.  The  child  at  first  dislikes  this  treatment,  but  soon  appreciating 
its  benefit,  will  run  to  the  nurse  on  the  first  warning  of  an  attack. 

An  ointment,  composed  of  half  a  drachm  of  chloroform  to  an  ounce 
of  lard,  will  often  allay  the  itching  of  urticaria,  lichen,  and  true  prurigo, 
but,  like  most  other  ointments,  it  loses  its  effect  in  a  short  time;  hence 
anti-itching  applications  require  to  be  changed  from  time  to  time. 

Dr.  Augustus  Waller  has  shown  that  chloroform  promotes  to  a  con- 
siderable extent  the  cutaneous  absorption  of  many  substances.  The 
absorption  of  watery  or  alcoholic  solutions  is  far  less  rapid.  The  chloro- 
formic  solutions  of  aconite,  atropia,  strychnia,  or  opium,  applied  to  the 
skin,  speedily  destroy  an  animal,  with  the  characteristic  toxic  symptoms 
of  the  alkaloid  employed.  He  ascribes  this  property  of  chloroform  to  its 
property  of  passing  rapidly  through  animal  textures,  carrying  with  it  the 
dissolved  alkaloid.  The  addition  of  a  certain  amount  of  alcohol  to  the 
chloroformic  solution  does  not  hinder  the  absorption  of  the  alkaloid — 


2  70  CHLOROFORM. 

indeed,  it  appears  to  liasten  it;  for  when  an  equal  quantity  of  alcohol  is 
added  to  the  chloroformic  solution,  the  absorption  is  more  rapid  than 
when  simple  cliloroform  is  used.  This  property,  either  alone  or  mixed 
with  alcohol,  should  be  borne  in  mind  in  employing  alkaloids  as  external 
applications. 

Chloroform  produces  in  the  mouth  a  sensation  of  warmth,  and  if  un- 
diluted excites  inflammation.  Being  a  stimulant  to  the  mucous  mem- 
brane it  excites  a  flow  of  saliva.  A  few  drops  on  cotton-wool  inserted  into 
the  hollow  of  a  decayed  aching  tooth  often  gives  permanent  relief,  but 
when  the  anfesthetic  effect  has  passed  away  the  pain  is  sometimes  aggra- 
vated, the  chloroform  having  irritated  the  inflamed  pulp.  It  is  a  good 
plan  to  fold  over  the  hollow  tooth  a  piece  of  linen  moistened  with  chloro- 
form, so  that  the  vapor  may  remove  the  pain.  Equal  parts  of  chloroform 
and  opium,  or  of  chloroform  and  creasote,  constitute  a  useful  application 
in  toothache. 

Chloroform  excites  a  sensation  of  warmth  in  the  stomach,  but  in 
large  doses  it  induces  nausea  and  vomiting.  One  to  three  drop  doses  of 
pure  chloroform  are  beneficial  in  flatulent  distensions  of  the  stomach, 
sea-sickness,  and  other  vomitings. 

Its  high  diffusion-j^ower  enables  it  to  pass  rapidly  into  the  blood,  lit- 
tle, if  any,  finding  its  way  into  the  intestines.  The  ph3'sical  and  chemical 
changes  produced  in  the  blood  by  its  admixture  with  chloroform  are  at 
present  unknown. 

When  given  in  medicinal  doses  to  a  healthy  jDerson  it  produces  very 
little  change,  either  in  the  frequency  or  strength  of  the  heart's  contrac- 
tions, though  when  inhaled,  judging  by  the  hasmadynamometer,  it  is  said, 
at  the  very  first,  slightly  to  increase  their  force.  In  disease,  on  the 
other  hand,  when  the  heart  beats  feebly,  especially  if  due  to  some  sudden 
and  transient  cause,  chloroform  certainly  strengthens  the  heart's  con- 
tractions, so  relieving  such  symptoms  as  syncope,  etc. ;  but  it  is  in  noway 
preferable  to  a  glass  of  brandy-and-Avater  or  wine.  It  no  doubt  acts  more 
ouickly  and  evanescently  than  alcohol,  and  its  cardiac  effect  certainh' 
declines  more  speedily  than  that  of  alcohol.  It  is  frequently  adminis- 
tered to  hysterical  patients  and  others  suffering  from  weakness,  depres- 
sion of  spirits,  nervousness,  etc.  Like  all  stimulants,  if  habitually  in- 
gested, it  soon  loses  its  effect,  and  this  es2:)ecially  happens  with  chloroform 
and  ether,  so  that  from  time  to  time  the  dose  requires  to  be  increased, 
and  even  then  these  drugs  soon  lose  their  efficacy. 

In  diarrhoea,  after  the  removal  of  the  exciting  irritant,  spirit  of  chloro- 
form may  be  given  with  much  benefit,  combined  with  astringents  and 
opium.  It  is  useful  in  intestinal  and  summer  colic,  from  whatever  cause 
arising,  and  in  renal  and  biliary  colic,  in  hiccup,  hysteria,  and  asthma, 
both  primary  and  secondary ;  and  from  the  relief  it  gives  in  these  affec- 
tions it  is  ranked  among  antispasmodics.  In  the  treatment  of  any  of  the 
foregoing  diseases  it  is  usually  combined  with  ojnum,  and  this  combination 
succeeds  admirably.  No  doubt  much  of  the  effect  is  due  to  the  opium, 
its  action,  it  appears,  however,  being  increased  and  sustained  by  the  chloro- 
form. Its  mode  of  action  is  at  present  unknown.  Fossibh-,  by  restoring 
the  weakened  muscular  or  nervous  system  to  its  natural  physical  condi- 
tion, it  controls  inordinate  muscular  action  and  removes  pain,  thi;s  be- 
coming a  true  stimulant.  Chloroform,  combined  with  small  doses  of 
morphia,  or  opium,  given  with  a  drachm  of  glycerine,  honey,  sugar- 
and-water,  syrup  of  lemons,  syrup  of  Virginia  prune,  or  treacle  and  water, 


CHLOROFOEM.  271 

is  often  conspicuously  beneficial  in  certain  coughs.  It  is  useful  when  the 
cough  is  paroxysmal  and  violent — violent  out  of  proportion  to  the  amount 
of  expectoration;  when,  indeed,  there  appears  to  be  much  excitability  or 
irritability  in  the  respiratory  organs,  and  when  a  slight  irritation  induces 
a  distressing  fit  of  coughing.  In  such  circumstances  the  chloroform  is  of 
more  service  than  the  opium,  and  should  be  given  in  a  full,  while  the 
opium  should  be  given  in  a  very  small,  dose.  This  combination  allays 
the  cough  in  the  fibroid  form  of  phthisis,  so  frequently  paroxysmal,  wear- 
ing, and  exhausting.  In  this  form  of  lung  disease  there  is  often  such  ex- 
tensive induration,  with  thickening  of  the  pleura,  as  to  prevent  any 
expansion  of  the  lung,  and  consequently  of  the  chest  walls,  so  that  little 
or  no  air  enters  the  consolidated  part  of  the  lung,  and  no  expulsive  force 
can  be  brought  to  bear  on  the  mucus.  Here  our  attention  should  be 
given  to  check  the  abundant  secretion,  to  lessen  its  tenacity,  and  so  facili- 
tate its  expulsion. 

Cough,  very  often  indeed,  arises  from  a  morbid  condition  of  throat; 
and  even  when  due  solely  to  lung  disease,  the  application  of  the  mixture 
just  recommended,  to  the  throat  and  parts  about  the  glottis,  is  often 
beneficial,  in  accordance  with  a  general  fact  that  remedies  applied  to  the 
orifices  communicating  with  certain  organs,  as  the  nipple,  rectum,  and 
throat,  will  by  nervous  communication  act  on  the  organs  themselves.  For 
example,  many  coughs  are  allayed  much  more  efficiently  if  the  opium  and 
chloroform  mixture  is  swallowed  slowly,  and  so  kept  in  contact  with  the 
fauces  as  long  as  possible. 

Being  highly  volatile,  much  chloroform  passes  off  by  the  lungs,  and 
its  odor  can  be  detected  in  the  breath;  some,  probably  for  the  same  reason, 
escapes  by  the  skin,  and  some  probably  by  the  urine.  In  its  passage  from 
the  lungs  it  is  unlikely  in  any  way  to  influence  the  mucous  membrane  of 
the  bronchial  tubes,  the  quantity  separated  being  very  small;  and  even 
during  and  after  the  inhalation  of  chloroform  we  do  not  observe  that  it 
modifies  in  any  way  the  secretion  of  this  membrane.  Its  influence,  if 
any,  on  the  kidneys  and  the  urine  is  at  present  unknown. 

Harley's  observations  on  the  action  of  chloroform  on  the  respiratory 
function  of  the  blood  tend  to  show  that  it  lessens  the  oxidation  of  the 
blood,  and  diminishes  the  evolution  of  carbonic  acid;  but  to  establish  this 
point  we  think  further  experiments  are  needed. 

We  will  now  give  a  succinct  and  practical  account  of  the  administration 
of  chloroform  as  an  anjesthetic.  It  is  needless  to  dwell  upon  the  signal 
and  beneficent  service  this  agent  has  in  this  respect  rendered  to  mankind. 

Chloroform  at  first  very  often  causes  a  sensation  of  tingling  and  heat 
in  the  lips  and  nose,  and  these  parts,  if  accidentally  moistened  with  it,  may 
become  inflamed,  even  to  blistering,  an  accident  which  can  always  be  pre- 
vented with  care,  particularly  if  the  nose  and  lips  are  first  smeared  with 
glycerine  or  cold  cream,  or  some  protecting  substance. 

The  early  sensations  experienced  vary  much  in  different  persons,  being 
sometimes  so  agreeable  as  to  tempt  to  the  inhalation  of  this  substance 
merely  for  the  sake  of  inducing  them;  but  in  the  majority  the  sensations 
are  more  or  less  disagreeable,  often  intensely  so. 

At  first  there  is  a  sensation  of  warmth  at  the  pit  of  the  stomach, 
spreading  to  the  extremities,  and  accompanied  by  some  excitement;  then 
some  or  all  of  the  following  symptoms  soon  set  in.  Xoises  in  the  ears, 
lights  before  the  eyes,  heavy  weight  and  oppression  of  the  chest,  great 
beating  of  the  heart,  throbbing  of  the  large  vessels,  and  a  choking  sensa- 


272  CHLOROFORM. 

tion.  These  symptoms  betoken  no  danger,  and  need  excite  no  apprehen- 
sion. At  the  very  commencement  of  the  administration  some  cough  is 
not  unfreqnently  excited,  or  even  a  passing  spasm  of  the  glottis,  sure 
signs  that  tlie  vapor  is  administered  in  too  concentrated  a  form,  and  tliat 
more  air  must  be  mixed  with  it,  by  opening  the  valve  in  Clover's  apparatus, 
or  by  removing  the  lint  farther  from  the  nose  and  mouth. 

At  this  early  stage,  women,  by  becoming  hysterical,  may  give  some 
trouble  and  alarm.  They  laugh,  sob,  or  cry;  their  breathing  is  often  ex- 
tremely irregular  and  hurried — a  condition  which  frightens  the  friends, 
and  inexperienced  chloroformers;  but  this  state  is  to  be  accepted  as  an 
indication  to  continue,  not  to  withhold  it;  for  this  condition  soon  subsides 
as  the  patient  passes  more  deeply  under  the  power  of  the  anesthetic. 

The  pulse,  at  first  cpiick,  and  it  may  be  weak,  if  not  due  to  the 
patient's  illness,  is  the  effect  of  nervousness  and  anxiety;  and  as  soon, 
therefore,  as  unconsciousness  sets  in,  the  pulse  falls  in  frequency,  and 
gains  in  force. 

A  few  seconds  from  the  commencement  of  the  administration  all  dis- 
comfort ceases,  the  patient  becomes  quiet,  breathes  calmly,  and  feels 
brave.  The  consciousness  is  now  more  or  less  affected;  questions  are  still 
heard,  but  are  slowdy  answered,  and  not  to  the  purpose.  The  induction 
of  this  medium  stage  is  adequate  for  confinement,  and  for  the  relief  of 
renal  colic. 

All  knowledge  of  the  external  world  soon  becomes  lost,  and  is  fol- 
lowed by  a  period  of  excitement.  Various  incoherent  ideas  occupy  the 
mind;  some  persons  struggle,  attempt  to  get  up,  and,  when  restramed, 
often  show  much  irritation.  The  stage  of  complete  unconsciousness  re- 
quired for  capital  operations  is  now  fast  approaching.  Violent  tonic  con- 
traction of  the  muscles  of  the  body  often  occurs  before  complete  uncon- 
sciousness and  perfect  muscular  relaxation  set  in.  The  extremities 
become  rigid,  the  muscles  of  the  chest  are  firmly  fixed,  and  the  respira- 
tion thus  becoming  impeded,  causes,  in  combination  with  the  general  vio- 
lent muscular  contraction,  duskiness  or  lividity  of  the  face.  The  e3'es 
are  injected  or  prominent,  the  lips  blue,  the  jugulars  stand  out  like  large 
black  cords,  the  mouth  is  clenched,  and  a  profuse  perspiration  Ijreaks  out  on 
the  body,  especially  about  the  face.  In  a  few  seconds  all  these  symptoms 
pass  away.  They  may  be  accepted  as  a  sure  indication  of  the  immediate 
approach  of  utter  insensibility,  and  complete  flaccidity  of  the  muscles, 
and  as  a  warning  that  the  administration  must  be  conducted  with  in- 
creased caution,  or  the  patient  Avill  suddenly  pass  into  a  state  of  danger, 
Tvith  noisy,  stertorous,  quick,  shallow  breathing,  and  quick,  weak  piilse. 
These  violent  muscular  contractions,  which  greatly  distort  the  face,  and 
frighten  the  patient's  friends,  rarely  occur  in  women  or  children,  or  in 
men  Aveakened  by  exhausting  illness;  and  it  is  a  condition  more  fre- 
quently seen  when  the  chloroform  is  administered  too  abundantly,  and 
the  patient  brought  too  quickly  under  its  influence. 

As  these  movements  cease,  the  mustdes  become  flaccid,  and  the  stage 
of  perfect  insensibility  is  reached.  Reflex  action  is  lost,  for  while  pre- 
viously the  brain  is  chiefly  affected,  now  the  spinal  cord  becomes  par- 
alyzed ;  the  conjunctiva  can  be  touched  without  producing  winking.  The 
limbs  when  raised  and  let  go  fall  heavily.  The  breathing  is  calm,  but  a 
little  superficial;  the  pulse  is  not  much  altered,  but  it  may  be  a  little 
more  compressible.  The  face  is  moist  with  perspiration.  The  pupil  is 
much  contracted.  This  condition  may  be  nuiintained  Avith  due  precau- 
tion for  a  considerable  time;  but  if  now  the  chloroform  is  continued  in 


CHLOROFORM.  273 

undiminished  quantity,  the  breathing  becomes  noisy  and  stertorous ;  the 
pupil  greatly  dilates;  the  pulse  loses  its  strength;  the  breathing  becomes 
more  and  more  shallow,  and  less  and  less  frequent,  till  both  pulse  and 
respiration  stop,  for  the  respiratory  centre  has  become  paralyzed.  Even 
now  artificial  respiration  will  often  restore  the  breathing,  bring  back  the 
pulse  beats  at  the  wrist,  and  restore  the  patient  from  the  jaws  of  death. 
On  several  occasions,  while  administering  chloroform,  I  have  witnessed 
recovery  from  this  critical  condition. 

On  the  other  hand,  it  appears  that  sometimes,  without  warning,  while 
the  pulse  is  beating  well  and  the  breathing  is  deep  and  quiet,  the  heart 
suddenly  stops,  and  respiration  immediately  ceases.  This  form  of  death 
arises  probably  from  cardiac  syncope,  while  the  other  form  of  death  is 
l^robaljly  due  to  paralysis  of  the  respiratory  muscles  from  the  effect  of  the 
chloroform  on  the  respiratory  centres.     (See  Belladonna.) 

Chloroform  insensibility  may  with  care  be  maintained  for  hours,  and 
even  days. 

In  administering  chloroform,  the  attention  should  be  directed  to  the 
state  of  the  pulse,  the  breathing,  the  conjunctiva,  and  the  pupil. 

The  pulse  usually  retains  throughout  its  frequency  and  force.  Should 
it  become  quick  and  weak,  or  irregular,  then  the  inhalation  must  be 
withheld,  unless  the  frequency  of  the  beats  can  be  accounted  for  by  the 
patient's  struggles.  The  breathing  often  affords  an  earlier  sign  of  dan- 
ger than  the  state  of  the  pulse.  If  the  respiration  becomes  very  shallow, 
and  gradually  less  frequent,  the  chloroform  should  be  suspended  for  a 
time. 

The  surest  signs  of  safety,  and  the  earliest  of  danger,  are  afforded  by 
the  state  of  the  conjunctiva  and  pupil.  While  irritation  of  the  conjunc- 
tiva causes  reflex  action,  and  is  followed  by  blinking,  there  is  usually  no 
danger.  The  pupil  is  much  contracted  in  the  stages  of  insensibility  when 
no  danger  is  to  be  apprehended;  but  on  the  approach  of  peril  from  over- 
dose of  the  anaesthetic,  the  pupil  dilates. 

It  is  concluded  that  chloroform  affects  the  pupil  by  first  stimulating,  and  then  para- 
Ij'zing  the  motor  oculi  nerve  centres,  for  during  the  contraction  of  the  pupil,  stimu- 
lation of  the  cervical  sj'mpathetic  is  without  effect,  but  when  the  pupil  begins  to  dilate, 
this  stimulation  increases  the  dilatation. ' 

When,  on  touching  the  conjunctiva,  reflex  action  is  annulled,  and  the 
limbs,  when  raised,  fall  heavily,  the  j)atient  is  fit  to  undergo  any  opera- 
tion. 
,  One  or  two  circumstances  require  a  passing  notice.     Vomiting  is  liable 

^  Dr.  Buxton  has  kindly  given  me  the  following: — "There  is  a  caution  neces.sary 
with  regard  to  permitting  operations  to  be  commenced  before  the  patient  is  completely 
under  the  influence  of  the  anaesthetic.  AVithout  attempting  to  theorize  as  to  the  cause, 
it  is  undeniably  a  dangerous  practice,  and  many  deaths  have  occurred  when  it  has  been 
followed.  It  should  in  every  case  be  made  a  rule  that  no  operative  measures  of  any 
kind  be  allowed  until  the  patient  is  in  the  stage  of  relaxation.  It  is  important  to  be 
al)le  to  obtain  early  warning  that  vomiting  during  chloroform  narcosis  is  about  to 
supervene.  The  pupil  will,  as  was  pointed  out  by  M.  Budin,  afford  a  clue.  He  found, 
and  my  experience  confirms  his  statement,  that  when  the  patient  is  about  to  vomit  the 
pupils  commence  gradually  to  dilate.  I  have  often  observed  efforts  at  swallowing  air 
are  initiated  at  this  time,  and  the  pulse  flags  slightly.  If  now  the  chloroformization  is 
discontinued,  the  pupils  widely  dilate,  vomiting  occurs,  and  the  patient  regains  con- 
sciousness rapidly.  But,  on  the  other  hand,  if  the  chloroformist,  aware  of  the  import 
of  the.se  signs,  piialiex  the  chloroform,  the  pupils  regain  the  contraction  which  is  normal 
to  the  state  of  relaxation,  and  vomiting  is  obviated,  while  the  pidse  recovers  its  force. 
The  gradual  dilatatif)n  spoken  of  above  must  not  l)e  confounded  with  tlie  sudden 
mydriasis  which  betokens  grave  danger.  In  this  last  case,  stertor,  shallow  breathing, 
and  marked  lessening  of  the  pulse-force  also  occur,  together  with  cyanosis." 
18 


274  CHLOROFORM. 

to  happen  if  food  has  been  taken  a  short  time  before  tlie  chloroform, 
occurring  either  as  the  patient  is  passing  under  its  influence,  or  more 
commonly  on  the  recovery  from  it,  ceasing  always  when  under  the  full 
effect  of  chloroform.  Vomiting,  happening  after  complete  chloroformi- 
zation,  may  he  taken  as  a  sign  of  returning  consciousness;  and,  if  the 
operation  is  uncompleted,  the  inhalation  should  at  once  be  continued,  when 
the  vomiting  will  speedily  cease.  But,  to  avoid  vomiting,  it  is  advisable 
that  the  patient  should  take  no  food  for  three  or  four  hours  before  choro- 
formization.  At  the  same  time  too  long  a  fast  should  be  avoided,  or  its 
very  purpose  may  be  defeated  by  inducing  the  tendency  to  vomit;  and 
fainting  and  much  exhaustion  may  occur  from  a  small  loss  of  blood  dur- 
ing the  operation.  The  head  should  be  turned  aside  to  assist  the  escape 
of  the  vomited  food,  and  to  prevent  choking. 

It  should  be  borne  in  mmd  that  operations  on  the  rectum  and  vagina, 
even  when  the  patient  is  quite  insensible,  often,  nay  generally,  cause 
noisy  catchy  breathing,  very  much  resembling  stertorous  breathing, 
often  mistaken  for  it,  and  sometimes  thought  to  indicate  that  too  much 
chloroform  has  been  administered;  but  this  is  not  the  case.  The  true 
state  of  things  can  generally  be  discriminated  by  a  little  attention  to  the 
circumstances.  Thus,  the  noisy  breathing  does  not  occur  until  the  rectum 
and  vagina  are  manipulated,  and  is  especially  loud  and  noisy  "when  the 
finger  or  an  instrument  is  passed  with  any  force  into  either  orifice. 

On  discontinuing  the  administration,  consciousness  usually  returns  in 
a  fcAV  minutes,  but  is  sometimes  delayed  for  a  longer  period.  If  perfect 
quiet  is  observed,  its  effects  are  often  followed  by  sleep,  which  refreshes 
the  patient,  gives  time  for  many  of  the  disagreeable  consequences  of  the 
inhalation  to  pass  off,  and  allows  the  pain  of  the  operation  to  subside. 

Experiment,  practice,  and  common  sense  show  that  the  danger  of 
chloroform  is  in  proportion  to  the  percentage  of  vapor  inhaled  in  the  air. 
The  importance  of  ascertaining  the  minimum  quantity  sufficient  to  bring 
the  patient  speedily  and  safely  to  a  state  of  insensibility  is  apparent.  Mr. 
Clover  had  shown  this  to  be  in  the  proportion  of  -i  to  5  per  cent,  of  chlo- 
roform vapor.  With  this  percentage,  insensibility  can  be  produced  in 
about  five  minutes,  with  the  minimum  of  danger.  In  animals  killed  by 
the  inhalation  of  this  proportion  of  chloroform,  the  -heart  will  continue 
to  beat  long  after  respiration  has  stoj)ped.  At  the  beginning,  Mr.  Clover 
administers  about  2  per  cent,  vapor,  and  as  the  patient  becomes  accus- 
tomed to  its  action  the  quantity  is  increased  till  5  per  cent,  is  reached. 

AVhen  any  serious  symptoms  arise,  and  danger  is  apprehended,  the 
chloroform  administration  should,  of  course,  be  discontinued,  and  artifi- 
cial respiration,  after  Sylvester's  method,  practised  instantly  and  assidu- 
ously, whether  the  breathing  has  ceased  or  is  growing  slower  and  shal- 
lower. AYhere  the  breathing  has  been  extinguished  in  a  gradual  manner, 
the  patient,  provided  artificial  respiration  is  instantly  adopted,  in  a  few 
seconds  in  most  instances,  fetches  a  deep  gasp,  which  is  soon  repeated, 
and  presently  the  breathing  grows  more  frequent,  till  it  becomes  natural, 
and  he  is  saved.  When  the  chest  has  ceased  to  move,  the  pulse  to  beat, 
and  when  the  patient  presents  all  the  appearances  of  death,  even  at  tliis 
crisis  life  may  generally  be  restored.  Little  is  to  be  hoped,  hoAvever, 
from  artificial  respiration  in  those  cases  where  the  breathing  and  pulse 
both  cease  immediately  without  any  warning.  Besides  the  use  of  artifi- 
cial respiration,  cold  water  should  be  dashed  over  the  face  and  chest,  air 
should  be  freely  admitted  and  all  hinderance  to  breathing  removed;  indeed. 


CHLOROFORM.  275 

everything  hampering  to  the  breathing,  as  stays,  or  a  tight  dress,  should 
he  removed  before  the  administration  of  chloroform.  The  most  serious 
impediment  to  the  breathing,  sufficient  to  endanger  life,  may  be  caused 
by  the  patient  lying  prone  for  the  convenience  of  the  operator.  Several 
times  I  have  witnessed  cases  of  imminent  danger  from  this  cause.  When 
this  position  must  be  assumed,  the  most  anxious  care  must  be  paid  to  the 
state  of  the  breathing;  for  this  prone  posture  is  itself  quite  adequate  to 
arrest  feeble  breathing,  which  without  this  impediment  would  go  on 
safely. 

It  is  a  question  of  importance,  whether  galvanism  should  be  used  in 
danger  from  chloroform.  The  Committee  appointed  by  the  Medical  and 
Chirurgical  Society,  are  of  opinion  that  this  agent  is  useful,  but  that  it  is 
far  inferior  to  artificial  respiration;  but  some  authorities  are  wholly 
opposed  to  its  use,  on  the  score  of  its  influence  to  arrest  a  very  feebly 
acting  heart,  and  so  diminishing  any  slight  remaining  hope  of  recovery. 
It  is  advised  to  apply  it  to  the  phrenic  nerve  to  stimulate  the  diaphragm 
to  action,  and  thus  maintain  breathing  till  the  chloroform  shall  have  had 
time  to  evaporate  from  the  blood,  and  the  system  become  free  from  the 
drug.  But  artificial  respiration  is  a  more  potent  agent  to  excite  the  res- 
piratory functions. 

It  has  been  ])roved  that  a  certain  percentage  of  chloroform,  amply 
sufficient  to  produce,  speedily,  complete  unconsciousness,  can  be  inhaled 
with  safety  for  an  almost  indefinite  time.  It  is,  therefore,  obvious,  that 
the  method  required  should  enable  us  to  give  this  percentage  with  cer- 
tainty throughout  the  most  protracted  operation,  so  that  the  proportion 
compatible  with  safety  shall  never  be  exceeded.  The  contrivance  which 
best  fulfils  this  condition  is  the  ingenious  apparatus  of  j\Ir.  Clover.  Its  • 
advantages  are  so  great  as  to  out-balance  fully  the  slight  inconvenience 
connected  with  its  use.  If  this  apparatus  is  not  at  hand,  we  may  adopt 
the  use  of  a  simple  piece  of  lint  and  a  towel,  or  Dr.  Simpson's  method,  or 
Skinner's  cone. 

Are  there  any  conditions  of  age  or  health  which  forbid  the  use  of 
chloroform  as  an  anaesthetic  ?  Provided  due  care  is  observed,  I  think  it 
may  be  given  to  all  persons  irrespective  of  their  condition,  having  myself 
given  it  without  any  threatening  symptoms,  in  serious  heart  disease,  in 
every  stage  of  phthisis,  in  Bright's  disease,  cancer,  chronic  bronchitis,  to 
patients  almost  dead  of  exhaustion  from  loss  of  blood,  to  children  of  a 
few  weeks,  and  to  persons  close  upon  a  hundred  years  old.  No  doubt  a 
dilated  or  a  fatty  heart  adds  to  a  patient's  risk,  and  enforces  on  the  opera- 
tor more  care  and  anxiety,  and  the  two  extremes  of  age  are  conditions 
which  exact  close  watching  whilst  giving  chloroform. 

Inhalation  of  chloroform  is  borne  better  by  the  weak,  those  depressed 
by  illness,  by  women  and  children,  than  by  healthy,  robust  men. 

As  might  be  expected  from  the  similarity  between  alcohol  and  chloro- 
form, we  find  that  persons  who  take  alcohol  to  excess  require  more  chlo- 
roform to  induce  unconsciousness. 

Chloroform  inhalation  is  now  frequently  used  with  much  advantage 
during  delivery;  it  eases  the  uterine  pains  without  increasing  the  danger 
to  mother  or  child.  It  is  not  necessary  to  obtain  complete  unconscious- 
ness, but  to  give  only  sufficient  chloroform  to  dull  the  pains.  If  this 
recommendation  is  disregarded,  and  the  antestlietic  is  pushed  to  the  stage 
of  complete  unconsciousness,  it  weakens  the  contraction  of  the  womb, 
and  retards  delivery.     It  is  true  that  even  if  only  slight  unconsciousness 


276  CHLOROFORM. 

is  produced,  the  uterine  contractions  are  probably  somewkit  weakened, 
but  accoucheurs  maintain  that  this  disadvantage  is  more  tlian  compensated 
by  the  relaxation  of  the  parts,  aiul  the  abatement  of  spasms.  ])r.  Play- 
fair,  who  thinks  chloroform  inhalation  is  too  indiscriminately  used,  says 
he  has  often  observed  the  pains  alter,  and  become  less  effectual  after 
chlorof ormization,  and  when  it  is  prolonged  he  thinks  it  favors  post-partiun 
haemorrhage.     (See  Chloral.) 

In  dental  operations  the  patient  incurs  some  additional  risk  of  syn- 
cope, owing  to  his  sitting  posture.  Chloroform  should  be  avoided  in 
dentistry;  indeed,  it  is  now  superseded  by  nitrous  oxide. 

Chloroform  inhalation  may  be  used  with  signal  benefit  in  renal  and 
biliary  colic.  In  my  experience  it  is  inferior  only  to  morphia  injection, 
and  is  very  far  superior  to  opium,  warm  baths,  and  the  ordinary  treat- 
ment in  vogue.  It  removes  the  severe  pain  before  unconsciousness  is 
reached;  indeed,  it  is  never  necessary  to  carry  the  admiiiistratipn  of  chlo- 
roform very  far.  The  pain  often  speedily  returns,  but  may  be  quelled 
again;  and  after  two,  or  at  most  three,  administrations,  it  is  often  per- 
manently removed. 

Chloroform  inhalation  in  the  treatment  of  chorea  is  sometimes  very 
valuable.  It  is  applicable  especially  to  those  serious  cases  in  which  vio- 
lent and  constant  movements  prevent  sleep,  and  even  the  swallowing  of 
food,  so  that  speedy  exhaustion  and  death  are  to  be  apprehended.  Chlo- 
roform in  such  cases  often  induces  refreshing  sleep;  indeed,  the  sufferer 
passes  from  the  insensibility  of  chloroform  into  that  of  natural  sleep,  and 
after  perhaps  some  hours,  wakes  up  soothed,  refreshed,  and  with  a 
marked  abatement  in  the  movements.  So  great  sometimes  is  this  im- 
provement, that  patients,  who  before  the  chloroform  could  scarcely  be 
restrained  in  bed,  after  waking,  sit  up  troubled  with  only  slight  involun- 
tary movemeiit,  and  eat  and  swallow  with  ease.  Soon,  however,  the 
movements  return,  when  the  inhalation  must  be  repeated.  At  first  it 
should  be  administered  three  times  a  day,  then,  proportioned  to  the  im 
provement,  twice,  and  after  a  time  once  a  day.  This  treatment,  it  is 
stated,  will  cure  the  disease,  on  an  average,  in  twenty-eight  days.  (See 
Chloral.)  In  delirium  tremens,  when  the  usual  means  fail  to  induce 
sleep,  it  has  been  advised  to  produce  unconsciousness  by  chloroform  in- 
halation. 

Chloroform  inhalation  will  arrest  convulsive  fits,  especially  in  children, 
sometimes  permanently.  Chloroform  inhalation  is  of  great  service  in 
puerperal  convulsions.  It  is  necessary  in  some  cases  to  maintain  uncon- 
sciousness for  hours,  or  even  days,  allowing  the  patient  to  wake  every 
three  or  four  hours  to  take  food. 

In  the  reduction  of  hernia  its  use  is  obvious.  It  may  be  used  to  assist 
the  diagnosis  of  abdominal  tumors,  when  deep-seated,  and  when  the 
walls  of  the  belly  are  hard  and  rigid.  It  is  useful  also  in  determining 
the  nature  of  phantom  tumors,  which  disappear  entirely  when  the  patient 
is  made  insensible  by  chloroform. 

Chloroform  inhalation  gives  relief  in  neuralgia,  sciatica,  colic  of  the 
intestines,  if  the  pain  is  very  severe,  in  distressing  dyspnoea,  whether  this 
is  due  to  asthma,  aneurism,  etc.  Mr.  Gascoin  reports  a  case  of  bronchitic 
asthma  much  benefited  by  rubbing  the  chest  for  an  hour  daily  with  lini- 
ment of  chloroform.  He  attributes  the  success  to  the  friction,  and  refers 
to  a  WidoAV  Pau,  who  has  obtained  a  reputation  in  Paris  by  using  fric- 
tion in  cases  of  asthma.     The  inhalation  of  a  few  whiffs  in  asthma,  with- 


CHLOROFORM.  277 

out  producing  unconsciousness,  sometimes  affords  relief,  and  should  the 
paroxysm  return,  on  the  effect  of  the  chloroform  passing  away,  the  inha- 
lation may  be  repeated.  A  small  quantity  of  chloroform  given  in  this 
way  often  suffices  to  avert  an  attack,  though  in  most  cases  the  effects  are 
only  transient,  the  paroxysm  returning  as  the  influence  of  the  drug  wears 
off.  Eight  or  ten  drops  on  a  lump  of  sugar  is  also  useful  in  a  paroxysm 
of  asthma,  and,  indeed,  in  other  spasmodic  diseases. 

Dr.  Bartholow  finds  injection  of  five  to  fifteen  minims  of  chloroform 
into  the  neighborhood  of  a  neuralgic  nerve  very  useful,  and  has  some- 
times a  permanently  good  effect.  He  finds  spirits  of  chloroform,  ether, 
or  alcohol,  likewise  beneficial.  It  must  not  be  forgotten  that  the  injec- 
tion of  chloroform  is  sometimes  followed  by  troublesome  ulceration. 

Dr.  Buckler  recommends  5  to  60  drops  of  chloroform  by  the  stomach 
in  biliary  colic,  repeated  every  four  to  six  hours.  It  is  said  to  dissolve 
the  calculus,  but  it  takes  several  hours'  immersion  in  chloroform  to  dis- 
solve even  a  small  calculus.  The  treatment,  however,  is  undoubtedly 
useful.  I  have  frequently  administered  five,  ten,  to  twenty  drops  on  a 
piece  of  sugar  every  quarter  of  an  hour  with  great  relief  to  the  joain. 
The  same  treatment,  or  half  a  drachm  to  a  drachm  of  ether  every  half 
hour,  is  very  useful  in  persistent  hiccup,  a  paroxysm  of  asthma,  and 
other  spasmodic  diseases. 

It  has  been  highly  recommended  in  drachm  doses  for  tape-worm, 
taken  in  the  morning  fasting,  after  a  light  supper  the  previous  evening. 
I  presume  few  will  treat  tape-worm  in  this  way,  and  the  recommendation 
is  chiefly  interesting  as  indicating  that  such  large  doses  may  be  taken 
without  risk,  at  least  by  many  persons.  Dr.  Davidson  Hcott  says  he  has 
given  a  drachm  dose  in  "  more  than  500  cases."  He  uses  it  as  a  hypnotic, 
this  dose  inducing  about  two  hours'  sleep.  He  has  "  frequently  "  given 
undiluted  chloroform  in  teaspoonful  doses  to  children  two  and  three 
years  of  age,  and  in  one  instance,  a  case  of  puerperal  convulsions,  he  gave 
undiluted  a  tablespoonful  of  chloroform,  which  arrested  the  convulsions 
and  induced  quiet  sleep. 

Insomnia,  tremulousness,  and  inability  to  fix  the  attention,  are,  it  is 
said,  apt  to  follow  the  repeated  use  of  chloroform  inhalation. 

In  some  experiments  with  Roy's  tonometer,  in  which  I  used  the  en- 
tire ventricle,  and  the  lower  two-thirds  of  the  ventricle,  I  find  that  chlo- 
roform, ethidene  dichloride,  and  bromide  of  ethyl,  will  paralyze  the  ven- 
tricle by  their  action  on  its  muscular  substance. 

I  find  that  chloroform  and  ethidene  dichloride  are  about  equally 
poisonous  to  the  heart's  substance.  These  experiments  show,  too,  that 
chloroform  and  ethidene  dichloride  are  far  more  poisonous  than  ether;  in- 
deed it  requires  about  80  to  100  minims  of  ether  to  arrest  the  ventricle, 
while  one  or  two  minims  of  cliloroform  is  sufficient.  I  also  find  that 
ammonia  and  chloroform,  ammonia  and  ether,  ammonia  and  bromide 
ethyl,  and  ammonia  and  iodoform  are  mutually  antagonistic.  After  the 
ventricle  is  arrested,  or  almost  arrested,  by  chloroform,  ethidene  dichlo- 
ride, ether,  or  iodoform,  the  pulsations  are  restored  and  strengthened  by 
the  addition  of  a  small  quantity  of  a  solution  of  caustic  ammonia. 


278  ETHER. 


ETHER. 


The  physiological  action  and  therapeutic  use  of  ether  and  chloroform 
are,  for  the  most  part,  identical. 

As  a  local  anaesthetic  in  neuralgia,  toothache,  etc.,  ether  is  less  fre- 
quently used  than  chloroform. 

In  the  form  of  spray,  after  the  method  introduced  by  Dr.  Eiehard- 
son,  ether  is  employed  temporarily  to  abolish  sensation  of  the  skin ;  the 
rapid  evaporation  of  the  ether,  and  consequent  abstraction  of  heat,  freeze 
the  tissues  and  annul  sensation.  Ether  spray  isfrequenth^used  in  minor 
operations,  as  the  opening  of  abscesses,  the  removal  of  small  tumors,  etc. 
It  has  been  successfully  employed  in  amputation  of  the  leg,  and  in  ova- 
riotomy, but  it  is  not  generally  available  in  operations  so  serious  and 
prolonged.  The  skin  or  mucous  membrane,  when  sufficiently  frozen  to 
permit  of  a  painless  operation,  becomes  pale,  shrunken,  tallowy -looking, 
and  feels  as  if  oppressed  with  a  great  weight,  "While  recovering  the  nat- 
ural condition  the  frozen  tissues  tingle  and  smart,  sometimes  so  intensely 
as  to  exceed  the  pain  of  operation.  The  obvious  advantage  of  ether  spray 
over  chloroform  inhalation  is  its  perfect  safety. 

Freezing  the  skin  with  ether  spray  sometimes  removes  sciatica  or 
neuralgia  permanently,  but  the  relief  general^  is  but  temjaorary.^ 

Ether  spray  applied  to  the  spine,  at  first  every  two  hours,  and  then 
less  frequently,  is  said  to  be  useful  in  tetanus,  and  ai^plied  night  and 
morning,  it  is  highly  commended  in  chorea. 

Ether  has  a  sweetish,  hot,  pungent  taste,  and  induces  a  sensation  of 
warmth  in  the  stomach.  Like  chloroform  it  may  be  taken  in  full  doses 
to  relieve  biliary  or  intestinal  colic.  It  increases  the  secretion  from  the 
stomach,  intestines  and  pancreas,  and  stimulating  the  muscular  coat  it 
expels  wind. 

After  its  absorption  it  stimulates  the  heart,  and  is  hence  employed  in 
syncope  and  in  prostration  in  fevers,  but  as  it  is  rapidly  eliminated  chiefly 
by  the  lungs,  its  effects  are  transient,  not  exceeding  generally  an  hour. 

Full  doses  of  ether  often  act  as  soporifics,  and  are  very  useful  in  angina 
pectoris,  sometimes  giving  even  more  prompt  and  permanent  relief  than 
nitrite  of  amyl.     It  is  useful,  too,  in  asthma. 

It  is  sometimes  employed  hypodermically  in  heart  failure  from  haem- 
orrhage or  from  general  diseases  and  adynamic  pneumonia,  etc.  Fifteen 
to  thirty  minims  are  injected  three  or  four  times  a  day.  The  injection 
excites  burning  pain  with  some  swelling,  which  subsides  generally  in  an 
hour  or  two,  but  sometimes  it  excites  suppuration.  It  is  also  employed 
in  sciatica,  being  injected  in  the  neighborhood  of  the  painful  nerve.  I 
have  employed  it  in  many  cases  of  heart  failure  from  various  causes,  with 
very  little,  and  often  without  any,  benefit. 

Ether  is  largely  used  as  an  inhalation  to  induce  angesthesia,  and  is 

'  Dr.  Debove  employs  methj'l  chloride  condensed  by  pressure,  to  congeal  the 
skin  in  neuralgia,  especially  in  sciatica,  and  claims  to  generally  cure  tlie  patient 
after  one  or  two  applicatio^is.  He  congeals  the  skin  over  tlie  area  of  pain,  in 
some  instances  from  the  trochanter  to  the  malleolus.  Tliis  application  freezes 
the  sivin  much  more  readily  than  ether,  but  requires  a  special  apparatus.  He 
saj's  it  causes  but  little  pain  and  no  inflammation  or  risk  of  sloughing.  I  have 
employed  this  appHcation  in  a  few  cases  and  with  some  success,  but  certainly 
with  less  than  Dr.  Debove's  account  led  me  to  expect  Moreover,  tlie  application 
in  ail  my  cases  induced  considerable  and  somewhat  enduring  pain. 


IODOFORM.  279 

generally  preferred  in  most  cases  to  chloroform,  for  ether  has  much  less 
effect  in  depressing  the  heart  and  paralyzing  the  vaso-motor  centre  than 
chloroform.  Like  chloroform  and  alcohol  it  affects  first  the  cerebral 
hemispheres,  causing  delirium  and  unconsciousness,  and  next  paralyzes 
the  spinal  cord,  affecting  last  the  cardiac  and  vaso-motor  centres. 

It  must,  however,  be  given  in  larger  doses  than  chloroform.  It  excites 
the  resj)iratory  mucous  membrane  and  may  induce  catarrh.  It  also 
greatly  increases  the  secretion  of  saliva  and  mucus. 

Dr.  H.  A.  Hare  has  recently  shown  that  prolonged  etherization  con- 
siderably lessens  the  body  temperature.  He  has  reduced  the  temperature 
from  8°  to  10°  Fah.,  and  in  operations  he  has  seen  a  fall  of  4.4°  Fah,  in 
man.  Probably  other  anesthetics  produce  the  same  effect.  ISome  sur- 
geons wrap  children  in  cotton  wool,  covering  not  only  the  body,  but  also 
the  extremities,  before  giving  the  anaesthetic. 


lODOFOEM. 


Iodoform  is  used  as  a  disinfectant,  an  antiseptic,  an  anassthetic,  and 
internally,  probably  by  virtue  of  the  iodine  it  contains.  It  contains  97 
per  cent,  of  iodine. 

Iodoform  is  a  healing  and  soothing  application  to  spreading  and 
sloughing  sores,  as  bed-sores,  rodent  ulcers,  and  especially  to  soft  chan- 
cres, and  is  said  to  prevent  buboes.  It  is  also  very  useful  in  syphilitic 
and  scrofulous  ulceration.  The  sore  dusted  over  with  iodoform  is  cov- 
ered with  some  bland  application,  as  glycerine  spread  on  lint.  Its  action 
in  chancrous  and  syphilitic  ulceration  is  often  prompt.  In  syphilitic 
sores  the  following  formula  is  very  useful:  Iodoform,  1  part,  oil  of  eu- 
calyptus, 15  parts.  It  has  been  successfully  employed  in  ulceration  of 
the  nose  and  thro  it  and  in  chronic  ozaena.  It  relieves  the  pain  of  cancer- 
ous sores.  Dr.  Moleschott  uses  it  as  an  ointment,  1  part  in  15,  for  en- 
larged scrofulous  or  simply  inflamed  glands  in  orchitis.  An  ointment 
composed  of  iodoform,  gr.  4;  oil  of  eucalyptus,  3  j;  vaseline,  1  j,  is  highly 
recommended  in  eczema.  When  employed  in  uterine  cancer,  a  bolus 
containing  from  eight  to  sixteen  grains  made  up  with  cocoa-nut  fat  is 
inserted  into  an  excavation  produced  by  sloughing  or  ulceration.  It  is 
useful  in  lupus,  and  should  be  dusted  several  times  a  day  on  the  ulcerated 
surface.  An  iodoform  suppository  is  also  useful  in  painful  diseases  of 
the  rectum  and  bladder. 

Dr.  Munday  highly  recommends  iodoform  as  an  antiseptic  dressing 
on  the  battle-field. 

Dr.  Tanturri  recommends  an  iodoform  ointment  of  3  j  to  3  j  for 
prurigo. 

Iodoform  is  said  to  relieve  the  pain  of  neuralgia  and  gout.  A  satu- 
rated solution  of  iodoform  in  chloroform  is  advised  in  neuralgia. 

One  would  expect  that  iodoform,  either  given  internally  or  inhaled, 
would  act  like  alcohol,  chloral,  and  chloroform,  and  this  is  true  in  some 
measure,  for  it  produces  sleep  and  some  anassthesia.  From  the  large 
quantity  of  iodine  it  contains  it  also  acts  when  applied  topically  and  when 
given  internally,  in  virtue  of  its  iodine. 

Though  containing  a  large  quantity  of  iodine,  iodoform  is  not  very 


280  IODOFORM. 

irritating  to  the  stomach.  In  large  doses  it  produces  a  kind  of  intoxica- 
tion followed  by  convulsions  with  tetanic  spasms,  high  fever,  mental  de- 
pression, dilatation  of  the  pupil,  involuntar}'-  evacuations,  hallucinations, 
sometimes  sudden  collapse  and  death.  It  is  often  employed  internally 
in  secondary  and  tertiary  syphilis. 

When  topically  applied  it  produces  in  some  2:)ersons  by  absorption 
serious  symptoms.     These  may  be  of  three  kinds : 

1.  Coated  tongue,  loss  of  appetite,  sickness,  even  diarrhoea. 

2.  Rapid  feeble  pulse,  140  per  minute,  perhaps  irregular,  with  other 
evidences  of  heart  failure. 

3.  Delirium,  active  and  furious,  with  hallucinations  or  melancholia, 
loss  of  memory,  coma,  and  not  uncommonly  convulsions  and  paralysis. 

These  symptoms  may  be  transient,  or  they  may  persist  for  weeks,  or 
they  may  destroy  life. 

In  children  these  symptoms  rarely  occur;  and  the  aged  are  much 
more  liable;  debility  favors  their  occurrence. 

It  has  a  depressing  action  on  the  heart,  and  when  given  to  frogs  it 
arrests  the  heart  in  diastole,  probably  by  its  action  on  the  nervous  gan- 
glia. 

In  fatal  doses  it  produces  fatty  degeneration  of  the  liver,  kidneys, 
heart,  and  voluntary  muscles;  acting  thus  like  chloroform  and  ether. 

Ten-grain  doses  of  potassium  bicarbonate,  given  hourly,  is  said  to  re- 
move these  poisonous  effects. 

Rummo  and  others  highly  recommend  a  four  per  cent,  solution  of 
iodoform  in  spirits  of  turpentine,  as  an  inhalation  or  spray  in  phthisis 
and  chronic  bronchial  catarrh.  It  lessens  cough,  expectoration,  and 
fever.  According  to  some  observers  it  is  also  useful  in  phthisis  when 
given  internally,  six  or  eight  grains  with  extract  of  gentian  daily.  Dr. 
Dreschfeld  confirms  this  statement,  and  finds  that  iodoform  increases 
appetite  and  weight,  diminishes  cough,  expectoration,  and  night  sweats, 
and  sometimes  even  lowers  the  febrile  temperature. 

It  is  employed  internally  in  doses  of  one  to  four  grains,  and  is  gener- 
ally given  when  iodides  are  useful.  Dr.  Bartholow  strongly  recom- 
mends it  in  catarrhal  jaundice,  and  in  cirrhosis;  especially  the  hyper- 
trophic variety,  if  the  disease  has  not  too  far  advanced.  He  believes 
cirrhosis  may  be  cured  by  the  persistent  use  of  iodoform  in  moderate 
doses.  It  appears  to  be  useful,  too,  in  phthisis,  when  administered  by 
spray,  as  an  inhalation. 

It  is  eliminated  by  the  breath  as  iodoform,  and  by  the  urine  as  iodide 
and  a  little  iodate.  Large  doses  may  cause  hematuria  and  albumin- 
uria, and  after  death  we  find  glomerular  nephritis.  It  is  said  that  it 
also  excites  acute  polio-myelitis. 

Its  local  application  having  caused  several  deaths,  it  is  now  less  ex- 
tensively used  than  formerly,  but  if  used  moderately,  there  appears 
to  be  little  or  no  risk. 


HYDRATE    OF    CIILOKAL.  281 


lODOL. 

Tetraiodopyeol  contains  eighty  per  cent,  of  iodine,  and  is  em- 
ployed in  place  of  iodoform,  having  the  great  advantage  of  being  free 
from  smell.  It  is  insoluble  in  water,  is  slightly  soluble  in  cold  alcohol, 
but  freely  in  warm  alcohol,  ether  and  oil.  Like  iodoform  it  is  anti- 
septic and  angesthetic,  and  appears,  when  a2)plied  locally,  to  be  much  less 
lioisonous  than  iodoform,  one  case  only  of  poisoning  having  been  at 
present  published.  Dusted  on  sores,  it  prevents  suppuration,  and  cleans 
gangrenous  wounds,  and  so  promotes  healing.  It  can  be  employed  as 
an  alcoholic  or  ethereal  solution,  1  in  16,  or  as  an  ointment,  five  per 
cent.,  or  as  gauze.  It  is  highly  useful  to  syphilitic  and  chancrous  sores. 
Internally  administered  in  two  to  four  grain  doses,  several  times  a  day, 
it  is  useful  in  secondary  syphilis.  The  pure  powder  applied  by  insuffla- 
tion is  useful  in  tubercular  ulceration  of  the  larynx. 

It  is  readily  absorbed  by  the  stomach,  and  iodine  speedily  appears  in 
the  saliva  and  urine.     It  is  eliminated  as  an  iodide. 

Given  in  large  doses  to  animals  they  emaciate  and  die,  and  fatty  de- 
generation of  the  organs  is  found,  especially  of  the  liver  and  kidney. 

In  one  case  of  poisoning  from  its  local  application  it  acted  like  iodo- 
form, inducing  fever,  a  rapid,  small,  irregular  pulse,  and  vomiting.  Al- 
though all  the  application  was  removed,  iodine  was  detected  in  the 
urine  for  two  weeks.  Like  iodoform  it  is  more  slowly  absorbed  and 
eliminated  than  iodides. 


HYDRATE   OF   CHLOEAL. 

This  valuable  soporific,  introduced  into  medicine  by  Liebreich,  when 
added  to  an  alkali,  decomposes  into  chloroform  and  formic  acid.  This 
led  to  the  employment  of  chloral,  with  the  expectation  that  the  alkali 
of  the  blood  would  slowly  set  free  the  chloroform.  It  appears,  however, 
highly  probable  that  although  a  small  quantity  may  be  decomposed  in 
the  blood,  that  it  remains  unchanged,  and  that  its  effects  are  due  to  the 
unchanged  chloral  hydrate.  In  support  of  the  view  that  chloral  is  de- 
composed in  the  blood  and  acts  as  chloroform,  several  observers  have 
obtained  chloroform  by  distillation  of  the  blood  of  animals  poisoned  by 
chloral;  but  probably  the  chloroform  is  given  off  by  the  heat  necessary 
for  the  distillation,  for  Hammarsten  found  that  on  adding  chloral  to 
blood,  and  passing  carbonic  acid  through  the  mixture,  he  failed  to  obtain 
chloroform,  but  on  subjecting  the  mixture  to  distillation,  chloroform 
was  readily  given  off. 

Further,  the  effects  of  chloral  differ  from  those  of  chloroform  and 
arc  more  prolonged;  no  chloroform .  is  exhaled  with  the  breath;  and 
chloral  hydrate  is  excreted  with  the  urine. 


282  HYDRATE    OF    CHLORAL. 

Chloral  is  antiseptic.  It  reddens  and  even  blisters  the  skin  wiien 
applied  in  concentrated  solutions.  It  has  a  hot,  pungent,  disagreeable 
taste,  which  may,  however,  be  considerably  covered  by  syrup  of  orange- 
peel  or  syrup  of  ginger.  It  quickly  enters  the  blood.  Its  most  marked 
effect  is  sleep,  and  after  larger  doses  there  is  lessened  sensibility  to  j^ain- 
ful  impressions.  It  lowers  blood  pressure  by  dilating  the  blood-vessels 
through  both  its  action  on  the  vaso-motor  centre  and  by  weakening  the 
heart.  It  at  first  accelerates  and  then  slows  the  pulse,  and  a  large  dose 
through  its  effect  on  the  cardiac  ganglia  arrests  the  heart.  As  on  the 
brain,  so  on  the  spinal  cord,  it  first  produces  slight  increased  activity, 
followed  soon  by  depression,  and  even  complete  paralysis.  It  contracts 
the  pupil;  in  larger  doses,  it  first  contracts  and  then  dilates  the  pupil  and 
greatly  reduces  body  temperature,  as  first  shown  by  Dr.  Brunton,  mainly 
by  increased  loss  through  dilatation  of  the  cutaneous  vessels,  and  in  a 
lesser  degree,  probably,  by  diminishing  heat  formation.  Large  doses 
induce  great  muscular  relaxation,  abolish  reflex  action  and  sensibility, 
and  the  animal  dies,  sometimes  through  the  loss  of  heat  or  by  j)aralysis 
of  respiration  or  paralysis  of  the  heart. 

The  most  characteristic  effect  of  chloral  is  sleep,  in  part  due  probably 
to  its  direct  action  on  the  nervous  structure  of  the  brain,  but  in  part 
also  to  the  ana3mia  it  produces  in  this  organ.  Thus,  Dr.  W.  H.  Ham- 
mond finds  that  at  first  chloral  congests  the  retina,  but  in  five  or  ten 
minutes  the  opposite  condition  commences,  and  continues  till  the  retina 
assumes  a  pale  pink  color.  As  the  retinal  circulation  corresponds  with 
the  cerebral,  he  concludes  that  chloral  affects  the  brain  in  the  same  way 
as  the  retina,  and  has  proved  the  correctness  of  this  inference  by  means 
of  an  instrument  called  the  cephalohasmometer,  invented  independently 
by  himself  and  by  Dr.  Weir  Mitchel.  Dr.  Hammond  says  that,  while 
tiie  brain  is  congested,  there  is  some  mental  excitement;  but  as  the 
vessels  contract,  drowsiness  supervenes;  and  on  this  wearing  off',  the 
retinal  and  cerebral  vessels  enlarge  till  they  assume  their  accustomed  size. 

Dr.  J.  H.  Arbuckle  ( West  Riding  Lunatic  Asylum  Reports,  vol.  v.)  finds  that  the 
following;-  substances,  Nicotia,  Atropia,  H^'oscyamia,  Aconitia,  Hydrate  of  Chloral, 
Nitrite  of  Amyl,  Prussic  Acid,  Strychnia,  Morphia,  Picrotoxine,  pushed  even  to  a 
fatal  dose,  do  not  in  any  degree  affect  the  circulation  at  the  fundus  of  the  e\-e. 
His  observations  were  made  on  rabbits,  and  the  results  they  obtained  were,  with 
respect  to  some  of  these  agents,  confirmed  by  experiments  on  man  ;  hence  the 
statement,  hitherto  generally  received,  that  the  retinal  circulation  corresponds 
with  the  cerebral  circulation,  changes  in  the  one  always  implying  changes  in  the 
other,  must  be  accepted  with  caution,  unless,  indeed,  some  of  these  drugs  act  on 
the  brain  in  a  manner  opposed  to  the  accepted  theory,  and  do  not  influence  it  by 
affecting  its  blood  supply. 

Hydrate  of  chloral  is  chiefly  employed  to  produce  sleep.  Chloral 
sleep  is  generally  calm,  refreshing,  and  dreamless,  not  too  profound 
to  prevent  waking  to  cough,  take  food,  etc.  As  a  general  rule,  chloral 
causes  no  giddine'ss,  headache,  nervous  depression,  constipation,  sickness, 
or  loss  of  appetite.  A  patient  roused  from  chloral  sleep  will  eat  a  hearty 
meal,  then  lie  down  and  immediately  fall  asleep. 

Chloral  at  first  sometimes  causes  a  good  deal  of  heaviness  and  sleepi- 
ness on  the  following  day,  but  this  effect  soon  wears  off.  It  occasionally 
produces  frightful  dreams,  and  sometimes  much  excitement,  intoxication, 
and  even  delirium  without  sleej). 


PI 


HYDRATE    OF    CHLORAL.  28.^ 

Sleep  comes  on  sometimes  in  a  few  minutes,  but  more  commonly  in 
half  an  hour,  after  a  dose  of  chloral.  Like  other  soporifics,  it  should  be 
given  shortly  before  bedtime,  and  the  patient  should  avoid  excitement, 
and  keep  quite  quiet,  else  it  will  produce  restlessness  instead  of  sleep. 
It  has  been  given  for  many  months  apparently  without  any  bad  results. 
Its  eifects  sometimes  wear  off,  but  in  a  far  less  degree  than  is  the  case 
with  opium.  Sometimes  instead  of  sleej)  it  induces  headache,  excite- 
ment, even  delirium. 

Chloral  as  a  hypnotic  has  been  found  useful  in  a  variety  of  circum- 
stances. It  subdues  the  sleeplessness  of  old  people,  and  the  wakefulness 
induced  by  excessive  mental  fatigue,  succeeding  sometimes  where  opium, 
bromide  of  potassium,  and  other  remedies  fail.  In  delirium  tremens  it 
produces  sleep,  and  calms  delirium;  but  is  especially^  successful  when 
administered  at  the  onset  of  the  symptoms,  often  averting  a  serious  ill- 
ness. Large  doses  have  been  given,  even  sixty  grains  or  more,  repeated 
several  times.  Dr.  Da  Costa  cautions  against  its  administration  to 
patients  with  a  weak  heart.  Large  doses  have  caused  serious  and  even 
fatal  results,  and  a  much  smaller  dose  should  at  first  be  tried  to  ascertain 
how  far  the  patient  tolerates  this  drug.  .  He  advises  its  combination  with 
opium.  In  paralysis  of  the  insane,  full  doses  induce  sleep  at  night,  and 
a  moderate  dose  calms  excitement  by  day.  Dr.  Macleod  has  given  it 
daily  to  the  same  patient,  without  bad  effects,  more  tlian  three  months. 
It  is  used  in  acute  mania. 

It  is  employed  in  puerperal  mania,  and  in  puerperal  convulsions.  It 
is  conveniently  administered  to  the  insane  in  porter. 

It  is  often  employed  in  fevers,  especially  typhoid  and  typhus  fever. 
In  fevers  it  often  happens  that  the  sleep  is  broken  or  the  patient  cannot 
sleep  at  all.  This  sleeplessness  rapidly  exhausts  the  nervous  system, 
hence  delirium  ensues,  followed  by  twitching  of  muscles  and  picking  of 
the  bed-clothes.  The  want  of  sleep,  especially  with  delirium,  raj^idly 
wears  out  the  strength  of  the  patient  and  soon  the  heart  shows  signs  of 
weakness,  the  pulse  increasing  in  frequency  and  losing  in  volume  and 
firmness.  Tlie  cardiac  failure  is  of  course  very  dangerous,  and  unless 
obviated,  may  end  in  death.  In  such  cases  so]3orifics  are  eminently 
serviceable,  for  by  inducing  sleep  we  prevent  or  remove  delirium,  pro- 
mote the  appetite  and  assimilation,  and  sustain  the  strength.  Soporifics, 
judiciously  employed,  often  save  life.  They  should  be  given  early,  before 
delirium  sets  in,  and  certainly  before  the  heart  becomes  weakened 
through  want  of  sleep  and  delirium.  For  this  purpose  chloral  is  very 
valuable,  often  inducing  calm  refreshing  slumber  from  which  the  patient 
can  be  awakened  to  take  food,  and  yet  fall  asleep  again.  But  whilst 
fully  recognizing  the  great  value  of  chloral  hydrate,  I  am  convinced  that 
opium  is  in  most  cases  still  more  valuable.  I  have  often  seen  moderate 
doses  of  laudanum  induce  sleep  where  chloral  has  failed,  or  has  induced 
disagreeable  and  dangerous  excitement.  Moreover,  laudanum  generally 
induces  a  gentle  perspiration,  most  comforting  and  favorable  to  fever 
patients;  moreover,  opium  strengthens  the  heart,  not  merely  by  induc- 
ing sleep,  but  by  its  direct  action  on  that  organ.  Further,  in  typhoid 
fever  laudanum  checks  diarrhroa.  The  combination  of  laudanum  (fifteen 
to  twenty  minims)  with  chloral  hydrate  (grains  ten)  is  still  more  certain 
in  its  action. 

In  the  sleeplessness,  or  the  dreamy,  unrefreshing,  broken  sleep  due 
to    worry,   overwork,  uterine    derangement   or   the  menopause,   chloral 


284  HYDRATE    OF    CHLORAL. 

hydrate  is  often  very  useful.  In  such  cases,  however,  I  am  convinced 
that  bromides  are  more  etHcacious. 

Chloral  sometimes  restrains  the  voluntary  movements  of  chorea,  but 
in  many  cases  it  is  powerless.  It  is  most  useful  in  those  cases  where  the 
violent  movements  render  sleep  impracticable,  the  want  of  sleep'in  its 
turn  aggravating  the  choreic  movements,  till  even  deglutition  may  become 
almost  impossible.  In  these  urgent  cases  ordinary  remedies  like  arsenic 
are  useless,  and  recourse  must  be  had  to  narcotics.  Large  doses  of 
chloral,  frequently  repeated,  will  often  produce  jjrof ound  refreshing  sleep 
from  which  the  patient  wakes  calmed  and  less  convulsed.  ( Vide  Chloro- 
form.) 

E.  Lambert  recommends  chloral  in  parturition  in  fifteen-grain  doses 
every  quarter  of  ^an  hour  till  the  patient  falls  asleep;  stating  that  this 
treatment  does  not  weaken  the  uterine  contractions,  while  it  prevents 
pain,  and  ensures  calm  repose  after  delivery.  Dr.  Playfair  thinks  that 
chloral  acts  far  better  than  chloroform  inhalation,  as  chloral  does  not 
lessen  the  strength  of  the  contraction,  whilst  it  greatly  lessens  the  suffer- 
ing. Moreover,  it  is  chiefly  apjilicable  at  a  period  when  chloroform 
"  cannot  be  used,  that  is  towards  the  termination  of  the  first  stage,  be- 
fore the  complete  dilatation  of  the  os."  The  patient  falls  into  a  drowsy 
state — a  sort  of  semi-sleep.  Dr.  Pla3"fair  gives  fifteen  grains,  and  repeats 
the  dose  in  about  twenty  minutes,  leaving  its  subsequent  administration 
to  circumstances. 

Chloral  is  often  useful  in  tlie  convulsions  of  children.  Given  in  a 
dose  sufficient  to  induce  sound  sleep  of  some  hours,  the  convulsions 
cease,  and  often  do  not  recur  when  the  child  wakes.  If  the  child  can- 
not swallow,  five  grains  given  by  the  rectum  soon  induces  a  deep  sleep, 
and  the  convulsions  then  cease,  at  least  temporarily.  The  liquid  injec- 
tion is  often  expelled  during  the  convulsions,  so  that  it  is  better  to 
administer  the  chloral  as  a  suppository,  pushed  as  far  as  the  finger  can 
carry  it.  It  is  also  very  useful  in  ura^mic  convulsions.  Indeed,  if  given 
in  a  sutficient  dose,  it  will  suspend  or  arrest  any  kind  of  convulsions. 

Bouchut  employs  chloral  hydrate  to  ^jroduce  general  ana?sthesia  in 
children.  To  children  about  seven  he  gives  forty-five  grains;  and  to 
children  from  two  to  five  he  gives  thirty  grains.  Anaesthesia  is  complete 
an  hour  after  the  administration.  The  drug  may  be  given  by  the 
rectum.     Children  bear  chloral  well. 

Five  grains  of  chloral  given  twice  or  thrice  daily  will  often  remove  a 
common  condition  characterized  by  restlessness,  irritability,  and  nervous- 
ness— a  condition  of  ceaseless  misery. 

Dr.  Bradbury  and  Dr.  Thompson  speak  very  highly  of  the  efficacy  of 
chloral  in  nocturnal  incontinence  of  children. 

Liebreich  recommends  chloral  in  sea-sickness;  fifteen  to  thirty  grains 
should  be  taken  every  four  hours.  It  is  sometimes  useful  in  the  vomit- 
ing of  joregnancy. 

xVccording  to  some  writers  a  hypodermic  injection  of  chloral  (five  to 
ten  grains)  is  very  serviceable  in  cholera.  It  is  said  to  remove  the  cramps 
and  coldness  of  the  breath,  and  to  save  life.  Bartholow  speaks  most 
highly  of  this  treatment,  and  says  it  acts  still  more  effectively  when 
combined  with  morphia. 

The  shortness  of  breath  affecting  the  emphysematous  on  catching 
cold  often  yields  to  chloral.  When  the  dyspnoea  occurs  at  night,  a  full 
dose  (twenty-five  to  thirty  grains)  at  bedtime  calms  the  breathing,  and 


HYDRATE    OF    CHLORAL.  285 

gives  sound  refreshing  sleep.  When  the  difficulty  of  breathing  is  con- 
tinuous, small  doses  (two  to  six  grains)  should  be  given  several  times 
daily. 

It  is  necessary  to  give  chloral  with  caution  to  patients  with  emphy- 
sema and  bronchitis  accompanied  with  obstructed  circulation,  causing 
lividity  and  dropsy;  for,  besides  drowsiness,  an  ordinary  dose  may  pro- 
duce muttering  delirium  and  a  notable  increase  in  the  lividity;  these 
effects,  often  lasting  several  days,  and  attributable  possibly  to  the  slow 
destruction  of  the  drug  in  the  blood,  seem  not  due  to  any  peculiarity  on 
the  part  of  the  patient,  as  I  have  seen  chloral  produce  these  symptoms 
in  a  patient  who  had  previously  taken  it  with  benefit. 

A  full  dose  of  chloral  is  often  useful  in  a  paroxysm  of  asthma. 

Some  cases  of  tetanus  have  apj^arently  yielded  to  chloral  in  large  doses ; 
and  in  some  instances  this  drug  has  prolonged  life  and 'eased  pain. 

The  statements  concerning  the  influence  of  chloral  on  pain  are  con- 
flicting, some  asserting  that  it  produces  ansesthesia,  while  Demarquay 
states  that  in  many  instances  it  excites  hypera?sthesia.  Chloral,  it  is 
said,  simply  makes  a  patient  oblivious  of  pain;  but  if  the  pain  is  too 
urgent  to  permit  of  sleep,  chloral  fails  to  give  relief.  This  metaphysical 
explanation  is  certainly  incorrect;  the  truth  being  that,  for  some  unex- 
plained reason,  chloral  in  certain  cases  subdues  pain,  while  in  other 
apparently  similar  instances  it  fails.  Chloral  sometimes  relieves  the  pain 
of  neuralgia,  chronic  rheumatism,  gall  stones,  colic,  and  gastralgia.  In 
doses  of  ten  grains,  three  times  a  day,  it  has  relieved  most  severe  pain 
of  cancer,  without  inducing  drowsiness.  Injected  hypodermically,  it  is 
liable,  like  chloroform,  to  excite  inflammation,  and  to  produce  an  abscess 
followed  by  a  scar. 

Chloral  is  very  inferior  to  opium  as  a  narcotic  for  the  relief  of  pain ; 
in  painful  affections  opium  or  morphia  must  be  used,  as  chloral  will 
often  fail. 

Chloral  if  too  long  continued  may  induce  disagreeable  symptoms, 
capricious  appetite,  impaired  digestion,  deficient  secretion  of  bile,  de- 
pression, nervousness,  irritability,  sleeplessness,  and  even  slight  paralysis, 
symptoms  which  soon  disappear  on  leaving  off  the  drug.  Eedness,  in- 
jection and  ecchymoses  of  the  skin  have  been  observed  in  some  cases. 

When  equal  parts  of  chloral  and  powdered  camphor  are  rubbed 
together,  they  form  a  syrupy  liquid,  which,  painted  on  the  painful  part, 
or  gently  rubbed  in,  often  affords  relief  in  neuralgia.  My  friend,  Dr. 
George  Bird,  has  used  this  compound  in  several  cases  of  neuralgia  and 
pleurodynia,  with  great  success.  I  have  known  it  cure  promptly  neuralgia 
of  the  inferior  dental  branch  of  the  fifth  and  neuralgia  in  the  temporal 
region.  It  is  said  often  to  relieve  toothache,  even  Avhen  applied  exter- 
nally, and  I  have  known  it  succeed  when  put  into  the  cavity  of  the 
carious  aching  tooth;  but,  like  other  applications,  it  often  fails  in 
neuralgia  without  apparent  cause,  in  cases  very  similar  to  others  it  has 
benefited.  When  it  does  answer,  this  liniment  generally  affords  almost 
instantaneous  relief.     I  have  known  it  give  relief  in  severe  pleurodynia. 

Chloral  hydrate  is  antiseptic  and  is  recommended  highly  as  a  topical 
application  in  diphtheria.     Some  use  a  saturated  solution  in  glycerine. 

As  we  occasionally  meet  with  persons  who  display  an  idiosyncrasy 
regarding  chloral  hydrate,  it  is  wise,  therefore,  at  first  to  give  only  a 
moderate  dose  of  ten  to  fifteen  grains.  Large  doses  we  have  seen  M^eaken 
the  heart.     We  are,  therefore,  often  cautioned  against  giving  chloral 


286  HYDRATE    OF    CHLORAL. 

where  the  heart  is  weak,  and  other  hypnotics,  like  paraldehyde,  are 
recommended  in  its  jjlace,  but  in  moderate  doses  of  fifteen  to  twenty-five 
grains  I  have  never  seen  it  produce  any  depressing  elfect  on  the  heart. 
The  large  doses  recommended  by  some  writei's  in  delirium  tremens  must, 
of  course,  be  given  with  caution — indeed  I  believe  had  better  not  be 
given  at  all.     Other  soporifics  should  be  tried  instead. 

Chloral  is  the  antidote  of  strychnia,  physostigma,  and  picrotoxine; 
that  is  to  say,  if  the  known  minimum  fatal  dose,  or,  rather,  more  than 
fatal  dose,  of  one  of  these  substances  is  given,  chloral  will  either  prevent 
death  or  greatly  modify  the  symptoms  induced  by  any  of  these  poisons. 
(See  Strychnia  and  Calabar-beau.) 

Liebreich  asserts  that  strychnia  is  an  antidote  to  chloral.  The  urine 
of  chloralized  animals  contains  no  sugar.  Eckhard  finds  that  chloral  pre- 
vents the  appearance  of  sugar  in  the  urine  after  the  diabetic  puncture 
of  the  floor  of  the  fourth  ventricle.  Even  after  severe  injury  to  the 
vermiform  process  diabetes  was  absent.  Chloral  hydrate  also  prevents 
the  diabetes  inducible  in  animals  by  reflex  action,  as  irritation  of  the 
central  end  of  a  cut  vagus. 

Dr.  Levenstein  reports  the  extraordinary  case  of  a  man,  aged  35,  who 
was  poisoned  by  six  drachms  of  hydrate  of  chloral.  AVhen  first  seen,  he 
lay  in  a  profound  sleep,  with  congested  face,  heavy  breathing,  and  pulse 
of  100.  An  hotir  after  the  j^oisoning  he  became  livid,  the  veins  were 
distended,  the  respirations  were  intermittent,  and  his  temperature  was 
103°  Fah.  An  hour  and  a  half  after  the  dose  he  became  pale,  pulseless, 
with  contracted  pupils,  and  his  temperature  had  sunk  to  91.2°.  Xitrate 
of  strychnia,  enough  to  produce  twitching,  was  then  injected  hypodermi- 
cally,  and  the  heart  at  once  began  again  to  beat,  and  the  thermometer 
marked  91.9°  Fah.;  collapse,  however,  returned  in  a  few  minutes,  the 
circulation  appearing  to  stop.  Artificial  respiration  was  performed  and 
nitrate  of  strychnia  again  injected,  again  with  the  same  result.  In  ten 
hours,  the  pupils  responded  to  light;  in  twelve,  the  temperature  was 
100.4°;  in  twenty-four  hours,  he  could  be  roused,  and  after  thirty-two 
hours,  he  awoke  "  quite  refreshed,"  and  did  not  complain  of  any  gastric 
disturbance. 


PARALDEHYDE.  287 


PARALDEHYDE. 

This  substance,  a  polymeric  modification  of  aldehyde,  has  recently 
been  introduced  into  medicine  as  a  hypnotic  by  Cervello  of  Palermo; 
and  Moseli,  Popoff,  Desnos,  and  Leech  in  this  country  have  contributed 
valuable  papers  on  the  subject. 

It  is  a  drug  still  on  its  trial,  but  the  accounts  given  of  it  show  that 
it  is  a  valuable  narcotic  with  a  role  of  its  own,  but  in  its  action  much 
like  chloral;  but,  unlike  that  drug,  paraldehyde  does  not,  except  in  toxic 
doses,  depress  the  heart.  Its  very  disagreeable  and  nauseous  taste,  which 
may  persist  long  after  it  is  taken,  difficult  to  cover  with  flavoring  agents 
like  syrup  of  orange-peel,  will  probably  prevent  its  extensive  employment. 
However,  it  can  be  well  administered  by  the  rectum. 

Its  effects  are  usually  rapid.  After  fifty  minims  quiet,  refreshing, 
dreamless  sleep  supervenes  in  from  five  to  fifty  minutes,  and  if  the 
patient  is  roused  there  is  no  confusion  of  ideas.  The  sleep  lasts  from 
two  to  six  hours.  Sometimes,  before  inducing  sleep,  it  causes  slight 
excitement,  and  the  heart's  action  is  often  at  first  somewhat  accelerated 
as  if  with  alcohol.  It  produces  as  a  rule  no  bad  after  effects  like  head- 
ache, sickness,  or  depression,  and  it  may  be  continued  for  months.  It  is 
said  to  be  slightly  auEesthetic,  but  if  the  jDatient  suffers  from  pain  or 
annoyance  from  cough  paraldehyde  is  not  of  much  avail.  It  rarely 
causes  nausea  or  vomiting,  but  if  the  stomach  is  irritable  it  may  do  so, 
and  even  cause  cramp  in  the  abdomen.  It  sometimes  produces  a  roseo- 
lous  rash.  In  toxic  doses  it  at  first  weakens  and  at  last  destroys  sensi- 
bility, reflex  action,  and  voluntary  power. 

Small  doses  first  increase  excitability  of  the  cortex  of  the  brain ;  large 
doses  from  the  first  greatly  depress  this  excitability.  It  affects  sensi- 
bility and  reflex  action  by  its  influence  on  the  spinal  cord.  It  leaves  the 
sensory  and  motor  nerves  and  the  muscles  unaffected.  A  large  thera- 
peutic dose  does  not  affect  the  heart  nor  the  arterial  tension,  but  a  toxic 
dose  first  retards  and  then  accelerates  and  weakens  the  heart's  action 
and  lowers  arterial  tension,  ultimately  arresting  the  heart  in  diastole. 
It  is  said  to  increase  the  urinary  secretion,  but  other  observers  have  failed 
to  detect  any  action  on  the  kidneys.  Toxic  doses  kill  by  paralyzing  the 
respiratory  centre,  the  heart  continuing  to  beat  for  some  time  after. 

Paraldehyde,  having  so  little  action  on  the  heart,  is  indicated  in  cases 
of  cardiac  weakness  which  forbid  the  use  of  chloral. 

It  is  highly  recommended  as  a  hypnotic  in  mania;  in  chronic  forms 
of  mental  weakness  accompanied  by  agitation ;  and  in  hysterical  excite- 
ment.    It  has  relieved  the  severe  pain  of  cerebral  tumor. 

It  has  been  recommended  in  epilepsy  in  place  of  bromides. 

It  is  excreted  in  part  by  the  breath,  which  may  smell  of  the  drug  for 
one  or  two  days  after  its  administration. 

Patients  rapidly  grow  accustomed  to  it. 

It  IS  antiseptic. 

The  narcotic  dose  for  an  adult  is  from  30  to  50  minims. 

The  taste  can  be  partially  covered  by  giving  it  in  sugar-and-water, 
and  adding  fifteen  drops  of  tincture  of  orange-peel. 

I  have  only  compared  the  eft'ects  of  paraldehyde  with  those  of  chloral 
hydrate  in  moderate  doses.    For  instance,  I  very  rarely  exceed  from  twenty 


288  HYDRATE   OF    CROTON-CHLORAL. 

to  twenty-five  grains.  In  these  quantities  I  have  not  yet  met  a  case  of 
fever  or  of  lioart  disease  at  all  depressed  by  chloral  hydrate,  hence  I  have 
not  been  able  to  observe  any  superiority  on  the  part  of  paraldehyde  over 
chloral.  A  few  cases  I  have  heard  of  where,  from  some  individual  jjecul- 
iarity,  even  small  doses  of  chloral  excited  disagreeable  symptoms,  and  in 
these  instances  paraldehyde  acted  excellently  without  any  discomforting 
effects.  On  the  other  hand,  the  taste  of  paraldehyde  is  far  more  offensive 
than  the  taste  of  chloral  hydrate,  so  that  many  persons  are  made  sick 
by  paraldehyde,  and  many  positively  refuse  to  take  a  second  dose.  AVe 
are  particularly  cautioned  not  to  give  chloral  where  heart-weakness  of 
any  extent  exists,  and  paraldehyde  in  such  cases  is  highly  spoken  of. 
Cardiac  weakness  is  mostly  met  with  in  lack  of  compensation,  as  in  aortic 
regurgitation,  or  mitral  disease,  and  in  fevers.  In  the  cardiac  weakness 
of  deficient  compensation,  often  displaying  itself  in  cardiac  dyspnoea, 
by  which  the  rest  is  broken,  I  find  laudanum  by  the  mouth  or  morphia 
hypodermically  is  by  far  the  best  narcotic.  It  strengthens  the  heart, 
obviates  the  dyspnoea,  and  permits  refreshing  sleep.  The  addition  of 
ten  to  fifteen  grains  of  chloral  no  doubt  increases  the  action  of  lau- 
danum, and  is  a  dose  that,  certainly  never  in  ray  experience,  depresses  the 
heart. 


UKETHAN. 


A  NEW  hypnotic,  introduced  by  Schmiedeberg,  but  already  falling 
into  disuse,  is  a  tasteless  powder,  insoluble  in  water,  but  readily  dissolved 
and  absorbed  by  the  stomach.  Schmiedeberg  considered  that  the 
alcohol  radical  would  affect  the  cerebrum  whilst  the  amidogen  would 
stimulate  the  medulla  and  cord,  and  thus  it  would  be  free  from  danger 
to  respiration  and  the  heart.  It  does  not  disorder  the  stomach.  At  first 
it  induces  some  excitement,  soon  followed  by  sleep,  Avith  some  slowing 
of  the  pulse  and  resjiiration.  It  does  not  reduce  blood  pressure.  Large 
doses  depress  the  temperature  and  weaken,  and  even  destroy  the  re- 
flexes. The  sleep  is  like  that  of  chloral  or  paraldehyde,  and  ensues  in 
from  fifteen  minutes  to  an  hour.  It  does  not  relieve  pain.  It  must  be 
given  in  full  doses  of  twenty  or  thirty  grains,  which  may  be  repeated  iu 
an  hour  or  two  if  sleep  does  not  follow  the  first  dose. 


HYDRATE  OF  CEOTON-CHLORAL. 

We  are  indebted  to  Dr.  Oscar  Liebreich  for  introducing  this  valu- 
able agent  into  the  service  of  medicine.  This  distinguished  experi- 
menter finds  that  in  animals  it  produces  ana?sthesia  of  the  head  without 
loss  of  sensibility  of  the  rest  of  the  body;  and  in  man,  anaesthesia  of  the 
fifth  nerve  only.  In  large  doses  it  produces  sleep,  and  in  fatal  doses  it 
destroys  by  paralyzing  the  medulla  oblongata.  He  recommends  it  in 
trigeminal  neuralgia,  but  speaks  of  it  as  affording  only  temporary  relief; 
he,  however,  greatiy  underrates  its  efficacy. 


HYDRATE    OF    CROTON-CHLORAL.  289 

Croton-cliloral  is,  perhaps,  the  most  efficacious  remedy  in  facial 
neuralgia.  In  neuralgia  due  to  carious  teeth;  in  facial  neuralgia  in  old 
people,  in  whom  the  disease  is  generally  most  obstinate  and  severe,  it  is 
alike  beneficial.  In  the  few  cases  of  that  severe  form  called  epileptiform 
tic  that  I  have  had  the  opportunity  of  using  it,  it  has  proved  useless, 
even  in  large  doses.  I  have  found  it  very  serviceable  in  neuralgia  of  the 
back  of  the  head,  and  also  of  that  of  the  neck  with  pain  radiating  to  the 
shoulders.  There  is  but  little  evidence  at  present  of  its  effects  on 
neuralgia  of  the  other  parts  of  the  body;  though  it  is  reported  to  have 
cured  several  severe  cases  of  dysmenhorroeal  neuralgia.  I  have  not  found 
it  successful  in  neuralgia  of  the  trunk  and  extremities.  In  facial  neuralgia 
I  have  long  employed  with  great  benefit  three  grains  of  croton  chloral 
hydrate  with  1.200  of  a  grain  of  gelsemia,  administered  every  quarter  of 
an  hour  for  six  or  eight  doses,  and  then  hourly. 

I  have  found  hydrate  of  croton-chloral  very  useful  in  migraine,  com- 
monly called  sick  headache,  bilious  headache,  nervous  sick  headache,  and 
hemicrania.  The  most  characteristic  and  commonest  symptoms  of 
megrim  are  headache  and  sickness;  but,  in  a  typical  case,  these  symp- 
toms are  preceded  by  other  significant  and  interesting  phenomena.  At 
the  onset  of  an  attack,  a  peculiar  affection  of  the  sight  first  occurs,  soon 
to  be  followed  by  perversion  of  the  sense  of  touch  and  of  the  muscular 
sense  in  the  arms  and  legs,  by  disordered  speech  and  defective  ideation; 
the  headache  then  comes  on,  and,  as  it  becomes  intensified,  nausea 
gradually  sets  in. 

The  affections  of  the  sight  may  coAsist  of  mere  absence  of  vision, 
beginning  at  the  centre  or  circumference  of  the  visual  field.  When  at 
the  circumference,  the  defect  is  generally  situated  to  the  right  or  left  of 
the  axis  of  vision.  From  the  centre  of  the  visual  field,  the  blind  spot 
gradually  expands,  and  as  it  enlarges  it  then  clears  up  in  the  centre,  and 
so  gradually  disappears  to  the  circumference.  As  the  blind  spot  ex- 
pands, its  margin  is  often  lighted  up  with  spectra  variously  described  as 
glimmering,  dazzling,  bright  zigzag  lines,  coruscations,  etc. 

In  ten  minutes  to  half  an  hour,  numbness  and  loss  of  sensibility 
occur  on  one  or  both  sides  of  the  body,  followed  by  tingling  formication, 
"pins  and  needles,"  felt  most  distinctly  in  the  hands,  tongue,  and  lips. 
Speech  is  commonly  disordered,  the  aberration  in  some  cases  being 
simply  memorial,  in  others  simply  motorial;  in  others,  again,  these  two 
derangements  of  speech  are  more  or  less  combined.  In  other  words, 
,  one  patient  forgets  his  words,  another  forgets  how  to  utter  them,  whilst 
a  third  manifests  a  combination  of  these  two  defects.  There  is,  too,  loss 
of  memory,  confusion  of  ideas,  and  a  bewildered  feeling,  as  if  the  patient 
was  going  out  of  liis  mind.  In  half  an  hour  or  a  little  longer,  these 
phenomena  are  followed  by  headache,  which  is  generally  felt  on  waking 
in  the  morning;  is  at  first  slight,  but  intensifies  till  it  may  become  most 
severe — indeed  almost  unbearable.  It  affects  one  or  both  brows,  and, 
beginning  at  one  sj^ot  gradually  extends,  till  it  may  involv^e  the  greater 
part  of  the  head.  The  throbljing,  stal^bing,  cutting,  boring  pain  is  in- 
creased by  movement,  noise,  light,  smells,  or  food.  AVlien  the  area  of 
pain  is  limited,  the  complaint  is  termed  clavus.  As  the  pain  subsides, 
or  even  during  the  whole  attack,  the  patient  may  suffer  dull  or  shooting 
pains  in  the  eye  of  the  affected  side.  There  is  much  tenderness  of  the 
scalp  during  and  after  the  attack. 

Throughout  the  attack  the  patient  complains  of  nausea,  which  may 
19 


290  HYDRATE   OF    CKOTON-CHLORAL. 

be  slight,  but  usually  increases,  and,  when  the  pain  is  at  its  worst,  ends 
in  vomiting,  which  may  be  severe  and  prolonged,  causing  much  prostra- 
tion ;  yet  occasionally  vomiting  affords  relief. 

Lasting  a  few  hours,  the  whole  day,  or  even  two  or  three  days,  the 
attack  generally  ends  in  calm  refreshing  sleep,  but  sometimes  it  gradu- 
ally subsides  or  ends  abruptly  in  vomiting,  perspiration,  or,  more 
rarely,  a  copious  flow  of  tears.  The  attack  may  be  preceded  and  followed 
by  very  obstinate  constipation  or  by  diarrhrea,  the  liquid  motions  being 
in  some  instances  pale,  in  others  of  a  deeji-brown  mahogany  color.  Be- 
fore and  after  the  attack,  there  is  often  much  dusky  discoloration  around 
the  eyes. 

Dr.  Liveing,  to  whose  exhaustive  work  I  am  considerably  indebted, 
considers  that,  in  a  typical  case,  the  disturbance  takes  place  first  in  the 
optic  thalamus,  and  passes  backward  and  downward,  reaching  to  the 
nucleus  of  the  vagus  below;  for,  as  he  observes,  in  a  model  seizure  the 
visual  disorder  is  always  the  initial,  the  headache  the  middle,  and  the 
vomiting  symptom  the  final.  Where  morbid  intellectual  phenomena 
and  disorder  of  speech  occur,  the  affection  radiates  from  the  thalamus 
to  the  hemispheric  ganglia,  and  where  emotional  j^henomena  occur,  to 
the  mesocephale. 

Other  observers  regard  the  affection  as  seated  in  the  cilio-spinal  axis, 
and  to  be  of  two  forms,  one  depending  on  stimulation,  the  other  on 
paralysis  of  this  j)art.  When  due  to  stimulation  the  temj^oral  artery  is 
small  and  hard,  the  eye  prominent,  the  paljDcbral  fissure  more  widely 
open,  the  pupil  dilated  and  the* skin  of  the  face  pale;  where  the  attack 
is  paralytic  the  023posite  of  these  symptoms  occur. 

Though  the  affection  is  seated  in  the  nervous  centres,  yet  it  must 
be  recollected  that  both  the  frequency  and  the  severity  of  the  attacks 
depend  on  peripheral  exciting  causes,  due  to  the  stomach,  intestines, 
liver,  womb,  etc.  Even  when  the  affection  is  strongly  developed  and  the 
periodic  attack  occurs  apparently  spontaneously,  remote  exciting  causes 
may  render  the  seizures  more  frequent  and  severe ;  nay,  in  many  cases, 
the  affection  may  be  so  slight  that  it  lies  dormant  till  roused  into 
activity  by  some  near  or  distant  irritation,  which,  being  removed,  the 
seizures  cease. 

The  successful  treatment  of  megrim  depends  less  on  change  to  be 
effected  in  disordered  nervous  centres  than  on  the  removal  of  the  excit- 
ing cause. 

The  treatment  of  megrim,  therefore,  falls  under  three  heads: 

1.  The  treatment  of  the  central  nervous  affection. 

2.  The  removal  or  prevention  of  exciting  causes. 

3.  The  treatment  of  the  paroxysm. 

Many  remedies  act  in  a  twofold  or  even  a  threefold  way.  Thus 
bromide  of  jiotassium  is  often  extremely  serviceable  in  two  ways.  It  is 
very  useful  in  cases  where  the  seizure  is  due  to  uterine  disturbance, 
as  in  menorrhagia  and  dysmenorrhcea.  Sometimes  the  attacks  are  more 
severe  and  frequent,  arising  from  the  exhausted  state  of  the  nervous 
system.  Perhaps  from  over-long  town  residence,  or  from  mental  troubles, 
the  patient  becomes  irritable,  depressed,  nervous,  excitable,  with  broken 
sleep,  harassed  by  dreams.  The  ensuing  general  depression  increases 
the  headache.  Now,  bromide  of  potassium  soothes  the  jiatient  by  pro- 
moting a  refreshing  sleep,  and  thus  lessens  the  frequency  and  severity  of 
the  headaches.     Bromide  of  potassium,  moreover,  is  serviceable  in  the 


% 


HYDRATE   OF    CROTON-CIILORAL.  291 

paroxysm  itself,  for  it  may  produce  several  hours'  sleep,  from  which  the 
patient  awakes  free  from  headache. 

The  pain  of  megrim  is  situated  in  the  fifth  nerve;  and  remembering 
how  closely  megrim  is  allied  to  neuralgia,  and  how  useful  hydrate  of 
croton-chloral  is  in  facial  neuralgia,  I  have  been  induced  to  try  this 
remedy  for  megrim,  and  have  found  it  useful  in  cases  of  which  the  fol- 
lowing may  be  taken  us  a  type : 

A  woman  has  been  subject  for  years  to  nervous  sick  headache;  then, 
owing  to  some  great  trouble,  or  to  excitement,  fatigue,  or  flooding,  or 
prolonged  suckling,  or  more  often  at  the  change  of  life,  the  headache 
becomes  much  more  severe,  becomes  continuous  for  weeks,  perhaps 
months,  and  is  intensified  greatly  by  fatigue,  excitement,  or  at  the  cata- 
menial  period.  If  not  actually  continuous,  the  headache  comes  on  daily, 
lasting  perhaps  many  hours,  or  several  attacks  may  each  day  occur. 
The  pain  is  often  intense;  and  whereas  previous  to  the  oncoming  of  this 
intensified  form  of  headache,  the  pain  was  probably  limited  to  one  brow, 
it  now  affects  both,  perhaps  the  greater  part  of  the  head.  The  skin  is 
generally  very  tender.  There  is  also  a  sensation  of  bewilderment,  or,  as 
some  term  it,  a  stupid  headache,  and  the  patient  says  she  feels  as  if  she 
should  "go  out  of  her  mind."  The  sight  may  be  dim,  especially  during 
the  exacerbations  of  pain.  Some  patients  of  this  class  are  very  excitable 
and  irritable,  and  are  upset  with  the  slightest  noise.  Nausea  and  even 
severe  vomiting  may  occur  ■with  each  exacerbation  of  the  pain.  Five 
grains  of  croton  chloral  every  three  hours,  or  even  oftener,  will  give  in 
most  cases  considerable  relief.  I  need  hardly  say  that  the  drug  does 
not  entirely  free  the  patient  from  her  attacks;  but,  in  one  or  two  dnys, 
the  j)ain  ceases  to  be  continuous,  then  the  attacks  recur,  though  only 
once  or  twice  a  week,  the  interval  gradually  extending  till  an  onset 
occurs  only  every  week,  then  about  every  fortnight,  or  even  longer,  till 
the  illness  assumes  its  old  tj^pe  and  ji^i'iodicity.  In  some  cases,  a  week's 
treatment  suffices  to  bring  back  the  headache  to  its  original  type  of  an 
attack  once  in  three  or  four  weeks.  Then  the  croton-chloral  appears  to 
be  far  less  serviceable,  manifesting  but  slight  effect  on  the  periodical 
attacks.  In  many  cases  of  ordinary  periodical  headache,  the  patients 
say  that  in  the  milder  forms  the  drug  distinctly  lessens  the  severity 
and  duration,  but  in  the  severer  forms  it  is  without  effect,  even  when 
sickness  is  absent.  In  cases  accomjianied  by  severe  vomiting  and  retch- 
ing, croton-chloral  is  useless,  being  speedily  rejected. 

Croton-chloral,  I  have  found,  will  relieve  the  lighter  attacks  some 
delicate  and  nervous  women  experience  after  any  slight  fatigue  or  ex- 
citement. 

In  the  continuous  sick  headache  just  desci'ibed,  as  the  pain  grows 
better  so  the  cutaneous  tenderness  disappears.  It  seems  to  me  that,  in 
many  instances,  two  kinds  of  headache  co-exist,  sometimes  one  predomi- 
nating, sometimes  the  other.  One  appears  due  to  affection  of  the  cutane- 
ous nerves,  and  is  generally  accompanied  by  tenderness.  Patients  de- 
scribe the  other  as  a  "  stupid  headache,"  "  a  feeling  of  bewilderment," 
"  a  bewildering  headache."  After  the  dispersion  of  the  first  form  by 
croton-chloral  this  stupid  headache  often  continues,  but  is  ordinarily 
relievable  by  bromide  of  potassium.  Indeed,  in  many  cases,  I  have 
found  it  useful  to  combine  these  remedies.  Bromide  of  potassium  itself 
is  often  sufficient  in  certain  sick  headaches;  for  instance,  if  the  other 
symptoms  point  to  the  use  of  this  drug,  as  when,  in  addition  to  the  be- 


292  NITRITE    OF    A3IYL. 

wildering  or  stupid  headache,  the  j)atient  complains  of  broken  sleep,  is 
harassed  witli  disagreeable  or  frightful  dreams,  is  jDrone  to  be  very  irri- 
table and  excitable,  and  feels  as  if  she  should  "go  out  of  her  mind."' 
Bromide  of  potassium,  too,  is  often  useful  Avhere  the  continuous  or 
almost  continuous  form  of  sick  headache  is  associated  with,  and  is  prob- 
abl}^  due  to,  uterine  derangement,  as  menorrhagia.  The  drug's  efhcacy 
is  not  due  to  simply  checking  the  loss  of  blood,  and  ao  indirectly  im- 
proving the  health,  for  it  manifests  its  efficacy  before  the  occurrence  of 
the  next  flooding.  In  cases  like  this,  it  may  be  usefully  combined  with- 
cannabis  indica. 

In  the  treatment  of  the  paroxysm,  salicylate  of  soda,  or  antipyrin,  has 
now  quite  superseded  croton-chloral. 

I  have  already  referred  to  the  effect  of  croton-chloral  on  the  shooting 
pains  in  the  occijiital  and  auricular  nerves,  but  I  wish  again  to  revert  to 
them,  because  they  appear  in  many  cases  to  be  closely  allied  to  migraine, 
being  often  induced  by  the  same  circumstances.  Thus,  they  are  most 
common  in  women,  especially  when  in  depressed  health  or  subject  to 
worry.  Sometimes  the  attacks  are  associated  with  nausea,  and  even 
sickness.  The  pains  occur  in  short  stabs  running  in  the  course  of  the 
nerve,  and  not  in  enduring  jjaroxysms.  Croton-chloral  in  such  cases  is 
often  very  useful,  although  it  may  fail  where  the  health  is  greatly  de- 
j^ressed,  and  where  there  is  much  anaemia.  Sometimes  the  symptoms 
indicate  the  employment  of  bromide  of  potassium. 

Liebreich,  who  recommended  croton-chloral  as  a  soporific,  and  gives 
as  much  as  sixty  grains  for  a  dose,  thinks  it  superior  to  hydrate  of 
chloral,  since  whilst  it  produces  sleep  it  does  not  affect  muscular  tone, 
nor  interfere  with  the  circulation  or  resjiiration.  He  thinks  it  applicable 
in  cases  of  heart  disease.  Much  smaller  doses  are  said  to  prodiice  sleejj; 
thus.  Dr.  Yeo  states  that  sometimes  two  grains  will  suffice.  I  have 
given  five-  and  ten-grain  doses  in  a  considerable  number  of  cases,  but 
never  knew  either  dose  to  produce  sleep,  or  even  drowsiness. 

It  is  best  administered  in  a  ijill.  Three  grains  every  quarter  of  an 
hour,  for  an  hour  or  an  hour  and  a  half,  and  then  hourly,  will  generally 
relieve  neuralgia  without  causing  any  toxic  symptom.  Much  larger 
doses  may  be  given,  as  ten  grains  several  times  a  day.  It  is  of  little 
use  in  toothache,  unless  this  induces  neuralgia,  when  it  cures  the 
neuralgia,  but  leaves  the  toothache  unaffected. 


XITRITE  OF  AMYL. 

To  Dr.  Brunton  belongs  the  distinction  of  first  using  this  remedy, 
and  the  I'are  merit  of  correctly  inferring  its  therapeutic  effect  from  its 
jDhysiological  action.  It  must  give  him  the  highest  satisfactioji  to  know 
how  great  a  boon  his  scientific  insight  has  provided  for  the  hitherto 
almost  helpless  patients  under  the  anguish  of  angina  pectoris. 

In  thirty  or  forty  seconds,  whether  inhaled,  subcutaneously  injected, 
or  swallowed,  it  flushes  the  face  and  increases  the  heat  and  perspiration 
of  the  head,  face,  and  neck.     Sometimes  the  increased  warmth  and  per- 


NITRITE    OF   A3rYL.  293 

spiration  affect  the  whole  surface;  or,  while  the  rest  of  the  surface  glows, 
the  hands  and  feet  may  become  very  cold;  and  this  condition  of  the 
extremities  may  last  many  hours.  It  accelerates  the  pulse  in  a  very 
variable  degree,  sometimes  doubling  its  pace,  and  this  augmented  pulse- 
beat  precedes  the  flushing  by  a  few  seconds.  It  causes  the  heart  and 
carotids  to  beat  strongly,  and  the  head  to  feel  full  and  distended,  "  as 
if  it  would  burst,"  or  "  as  if  the  whole  blood  were  rushing  to  the  head," 
and  sometimes  produces  slight  breathlessness  and  cough.  It  often 
causes  slight  giddiness,  mental  confusion,  and  a  dream-like  state.  When 
given  to  animals  in  a  deadly  dose,  the  breathing  becomes  quick;  there  is 
great  weakness;  loss  of  reflex  irritability,  and  death  ensues  from  arrest 
of  respiratio7i,  but  sensation  and  consciousness  remain  unaffected. 

The  acceleration  of  the  heart  is  probably  due  in  part  to  the  lowered 
arterial  tension,  and  in  part  to  depression  of  the  vagus. 

The  most  characteristic  effect  of  this  drug  is  its  influence  on  the 
vascular  system.  It  relaxes  the  whole  arterial  system,  greatly  reducing 
arterial  pressure.  The  reduction  of  arterial  pressure  is  due  mainly  to 
the  great  dilatation  of  the  arterioles,  and,  after  large  doses,  to  depression 
of  the  heart.  How  does  it  dilate  the  arterioles  ?  It  will  dilate  the 
arterioles  even  after  section  of  the  cord  just  below  the  medulla  oblongata; 
hence  it  has  been  concluded  that  it  does  not  act  by  paralyzing  the  vaso- 
motor centre,  which  formerly  was  supposed  to  be  situated  between  the 
calamus  scriptorius  and  the  corpora  quadrigemina.  It  must,  therefore, 
act  either  on  the  vaso-motor  nerve  trunks,  or  on  the  muscular  coat  of 
the  arteries.  Some  have  concluded  that  it  affects  the  arteries.  Brunton 
believes  it  partially  paralyzes  the  sympathetic  ganglia  and  their  motor 
nerves. 

The  i^aralyzing  effect  on  the  arterial  system  is  well  shown  by  the 
sphygmograpliic  tracings,  the  flushing  of  the  face,  and  the  increase  in 
the  size  of  visible  arteries  like  the  temporal,  which  often  becomes  notably 
large — sometimes,  indeed,  doubled  in  size,  and  branches  previously  in- 
visible become  j^lainly  apparent;  and  by  the  interesting  fact  observed 
by  Talfourd  Jones,  who  while  cupping  a  patient  over  the  loins,  and  find- 
ing that  blood  would  not  flow,  administered  nitrite  of  amyl  by  inhala- 
tion, when  the  cuts  immediately  began  to  bleed  freely.  xVfter  an  inhala- 
tion, the  larger  arteries  are  slower  in  recovering  their  normal  size  than 
the  capillaries,  a  phenomenon  I  have  often  observed  in  the  temjjonil 
artery,  which  remains  enlarged  half  a  minute  or  longer  after  the  blush 
has  left  the  face. 

Dr.  Horatio  Wood  has  shown  that  the  loss  of  reflex  action  and  of 
voluntary  power  occurring  after  large  doses,  is  due  to  the  depressing 
action  of  the  drug  on  the  motor  tracts  of  the  cord,  and,  to  a  slight  ex- 
tent, on  the  motor  nerves  and  on  the  muscles.  It  appears  to  have  no 
effect  on  the  sensory  tracts  of  the  cord,  nor  on  its  co-ordinating  centres. 
It  abolishes  reflex  action,  but  whether  it  represses  the  reflex  function 
of  the  cord  is  uncertain,  as  it  may  act  simply  on  the  motor  part  of  the 
cord. 

The  inhalation  or  subcutaneous  injection  of  nitrite  of  am}^  produces 
in  rabbits  sugar  in  the  urine,  with  a  considerable  increase  in  the  quantity 
of  urine.  It  has  been  experimentally  shown  that  diabetes  is  produced  by 
dividing  the  sympathetic  nerve  of  the  liver,  and  thereby  causing  dilatation 
of  the  hepatic  vessels,  so  increasing  the  quantity  of  blood  passing 
through  the  liver.     Probably  nitrite  of  amyl  acts  by  its  influence  over 


294  NITRITE    OF    AMYL. 

the  vaso-motor  nerves,  increasing  the  quantity  of  hlood  passing  through 
the  liver. 

Dr.  Horatio  Wood  finds  tliat  nitrite  of  amyl  lowers  the  temperature 
by  checking  oxidation.  He  finds,  too,  tliat  the  inhalation  of  nitrite  of 
amyl  changes  both  arterial  and  venous  blood  to  a  chocolate  color,  due,  as 
Dr.  Arthur  Gamgee  shows,  to  the  formation  of  metha?moglobin,  and 
that  by  this  means  the  ozonizing  property  of  the  blood  and  hence  oxida- 
tion of  the  tissues  are  lessened. 

R.  Pick,  from  observations  on  himself  and  others,  finds  that  after  in- 
haling amyl,  if  the  eye  is  fixed  on  a  spot  on  a  blank  wall,  the  spot  itself, 
with  the  surrounding  surface,  appears  of  a  yellowish  hue,  the  yellow  circle 
being  encircled  by  a  violet  blue  halo,  with  undulating  lines  at  the  edge. 

Dr.  Brunton  first  employed  nitrite  of  amyl  with  signal  success  in 
angina  pectoris,  and  found  it  more  effective  than  any  other  remedy  he  had 
tried  in  this  painful  and  dangerous  disease.  During  an  attack,  his  patient 
suffered  from  throbbing  of  the  heart  and  carotids  as  high  as  the  ears,  with 
severe  precordial  pain  extending  to  the  right  arm,  though  the  usual  char- 
acteristic "  sense  of  impending  death  "  was  absent.  The  pulse  was  slightly 
quickened,  and  the  sphygmographic  tracing  became  modified,  for,  as  Dr. 
Brunton  states,  "  as  the  pain  increased,  the  curve  became  lower,  both  the 
ascent  and  descent  more  gradual,  and  dicrotism  disappeared.  This  form 
of  curve  clearly  indicates  that  the  arterial  tension  is  much  increased,  and 
can,  I  think,  be  due  only  to  contraction  of  the  small  systemic  vessels." 
The  increased  tension  first  led  Dr.  Brunton  to  employ  nitrite  of  am^d. 
In  the  case  in  question  he  attributed  the  attack  to  spasmodic  contraction 
of  some,  if  not  all,  the  small  systemic  and  pulmonary  vessels,  a  state  of 
arterial  tension  which  gave  way  to  the  jiitrite,  when  the  pain  disappeared. 
In  recurring  attacks,  the  patient  inhaled  the  nitrite  of  amyl,  and  always 
obtained  instantaneous  relief. 

It  is  now  very  largely  used  in  angina  with  considerable  success;  indeed, 
in  the  majority  of  cases,  no  other  remedy,  except  nitro-glycerine  and  ni- 
trite of  sodium,  affords  so  much  relief.  As  might  be  expected,  it  is  not 
uniformly  successful.  I  have  never  known  it  fail  to  give  some  relief, 
though  sometimes  this  is  very  transient,  the  pain  returning  as  soon  as  the 
physiological  effect  of  the  drug  passes  away.  Thus,  in  one  case,  due,  as 
we  discovered  after  death  to  aneurism  of  the  heart  immediately  below  the 
aortic  valve,  an  inhalation  always  arrested  the  pain,  but  after  a  few  seconds 
or  minutes  it  returned,  even  if  the  administration  were  several  times  re- 
peated, as  severely  and  persistently  as  though  no  amyl  was  used.  In 
another  case,  whilst  it  always  arrested  the  paroxysm,  it  took  ten  minutes 
to  give  relief,  and  seemed  in  no  way  superior  to  a  full  dose  of  ether,  which 
the  patient  preferred,  as  the  amyl  produced  so  much  giddiness  and  sensa- 
tion of  fulness  in  the  head.  In  other  cases,  however,  it  has  proved 
strikingly  successful.  In  one  desperate  case,  the  slightest  exertion  brought 
on  intense  pain,  but  armed  with  amyl,  the  patient  coald  always  at  once 
cut  short  the  attack,  so  that  now  he  can  walk  several  miles,  though  dur- 
ing his  Journey  he  is  obliged  to  employ  the  amyl  several  times.  It  has 
appeared  to  me,  that  by  summarily  checking  the  paroxysm,  the  attacks 
come  on  less  frequently  and  severely,  and  after  a  time,  require  a  much 
smaller  quantity  to  control  the  pain  ;  so  that  amyl  really  contributes  to 
the  prolonged  relief  of  these  unhappy  patients.  In  some  cases,  the  nitrite 
of  amyl  either  loses  its  effects  or  the  severity  of  the  attack  increases,  so 
that  the  drug  must  be  taken  in  increasing  quantities  and  at  shorter  inter- 


1 


NITRITE    OF    AMYL.  295 

vals.  Two  of  my  patients  kept  the  bottle  nearly  always  in  their  hands, 
sniffing  the  drug  every  few  minntes,  and  one  used  an  ounce  every  week 
for  over  a  year. 

Dr.  Talfourd  Jones  found  it  remarkably  successful  in  very  severe  at- 
tacks of  asthma,  removing  the  dyspnoea  immediately  and  averting  its  re- 
turn ;  others  too  have  found  it  very  useful.  In  my  hands  it  has  not 
proved  successful,  for  although  it  always  arrests  the  paroxysm,  yet  on 
cessation  of  the  physiological  effect,  the  dyspnoea  has  returned.  Jones 
found  it  beneficial  also  in  a  case  of  cardiac  dyspnoea,  accompanied  by 
extreme  anasarca  due  to  a  dilated  and  hypertrophied  heart. 

Dr.  Talfourd  Jones  advises  inhalation  of  the  nitrite  in  syncope,  and 
thinks  it  should  be  of  service  in  the  paroxysms  of  whooping  cough.  It  is 
useful  in  neuralgia,  at  least  in  neuralgia  affecting  the  fifth  nerve,  often 
easing  the  pain  at  once,  and  a  single  administration  will  sometimes  avert 
further  attacks;  but  so  signal  a  result  as  this  is  probably  very  exceptional. 
Dr.  Eichardson  finds  that  nitrite  of  amyl  arrests  in  frogs  the  convulsions 
due  to  strychnia.  In  this  way  he  has  saved  their  lives:  hence  in  strychnia 
poisoning  and  tetanus,  he  advises  a  trial  of  the  nitrite,  either  by  inhal- 
ation or  subcutaneous  injection. 

It  is  better  to  administer  the  amyl  by  inhalation,  for,  according  to 
Brunton,  it  will  not  answer  with  anything  like  the  same  certainty,  when 
given  by  the  stomach;  for,  in  the  striking  case  of  angina  pectoris  just 
cited,  he  gave  ten  minims  in  brandy  by  the  stomach,  with  the  effect  of 
staying  the  pain  for  only  a  short  time,  but  a  single  inhalation  afforded 
perfect  and  permanent  relief.  It  should  be  borne  in  mind  that  it  affects 
some  persons  much  more  than  others;  one  individual  being  able  to  inhale 
five  or  ten  drops  from  a  handkerchief,  or  to  breathe  the  fumes  from 
the  bottle  held  close  to  the  nose,  while  a  whiff  from  the  bottle  held  at 
a  distance,  will  affect  another  with  great  giddiness,  much  mental  confusion, 
and  general  weakness.  Patients  become  habituated  to  it,  so  that  after  a 
while  it  must  be  inhaled  several  times  before  it  affords  relief.  This  habit- 
uation is  well  exemplified  in  the  internal  administration  of  the  remedy. 
By  exposure,  it  gets  "  flat,"  and  loses  its  efficacy. 

Nitrite  of  amyl  is  generally  considered  a  powerful  and  even  dangerous 
remedy,  requiring  to  be  watched  with  great  care,  and  given  in  a  definite 
quantity.  I  am  sure  it  is  not  nearly  so  dangerous  as  is  generally  imagined, 
though  it  is  true  that  nervous  sensitive  women  are  far  more  powerfully 
affected  by  it  than  men.  No  doubt  its  administration  at  first  should  be 
conducted  by  a  doctor,  in  order  to  ascertain  how  far  the  patient  is  suscep- 
tible to  its  influence,  and  that  the  patient  may  learn  when  he  ought  to 
discontinue  the  inhalation,  but  after  one  or  two  trials,  patients  soon  learn 
how  to  administer  it  to  themselves.  I  have  now  five  patients  with  angina 
pectoris,  each  of  whom  carries  a  small  bottle  of  this  medicine,  and  on  the 
first  warning  of  an  attack,  whether  Avalking  or  standing,  each  at  once  be- 
gins to  sniff  at  the  bottle.  My  patients  have  done  this  for  months,  and 
one  for  just  a  year,  using  the  inhalation  many  times  daily,  so  that  he  con- 
sumes two  drachms  a  fortnight  with  still  unfailing  relief.  Except  in 
relieving  the  angina,  the  amyl  seems  to  produce  no  other  effect  on  the 
system. 

Dr.  Jones  recommended  a  trial  of  it  in  epilepsy.  To  an  epileptic  patient, 
who,  in  addition  to  severe  and  repeated  attacks,  suffered  from  much 
mental  confusion,  and  Avas  haunted  many  times  a  day  with  an  indescrib- 
able dread  and  sensation  as  of  an  oncoming  fit,  although  it  came  on  only 


296  NITRITE    OF    AMYL. 

once  or  twice  a  week,  I  gave  three  drops  thrice  daily,  and  an  additional 
dose  on  the  earliest  warnings  of  a  fit,  with  the  effect  of  diminishing  con- 
siderably the  frequency  of  the  attacks,  and  entirely  removing  the 
harassing  sensations. 

Sir  Crichton  Browne  has  lately  jjublished  some  observations  on  the 
inhalation  of  nitrite  of  amyl  in  this  disease.  In  two  rabbits  made  arti- 
ficially epileptic,  he  prevented  the  oncoming  of  the  convulsions  which 
otherwise  follow  the  application  of  the  electrodes  to  the  brain,  by  mak- 
ing them  inhale  nitrite  of  amyl.  He  likewise  arrested  epileptic  attacks 
on  the  occurrence  of  the  aura  before  the  onset  of  the  fit,  and  has  even 
cut  short  the  fit  after  its  commencement.  By  the  same  means  he  has 
rescued  several  patients  out  of  that  desperate  jolight  called  status  epilep- 
ticus — a  condition  consisting  essentially  of  a  succession  of  fits,  linked 
together  by  intervening  unconsciousness,  the  fits  recurring  with  increas- 
ing frequency,  till  at  last,  no  sooner  is  one  fit  ended,  nay,  before  it  has 
finished,  another  fit  begins. 

Amongst  other  successful  cases,  Dr.  Weir  Mitchell  reports  one  where 
the  inhalation  was  used  immediately  the  aura  was  i^erceived,  and  other 
instances  where  the  spasms  lasted  for  hours,  one  fit  following  another.  I 
have  given  this  remedy  with  considerable  success  to  epile])tic  out-patients, 
in  whom  the  attacks  were  very  frequent.  In  some  it  has  appeared  to  be 
more  useful  than  full  doses  (20  to  30  gr.)  of  bromide  of  potassium  thrice 
daily;  in  another  case,  whilst  it  decidedly  lessened  the  frequency  of  the 
attacks,  it  was  less  serviceable  than  bromide  of  potassium.  I  have  given 
it  in  two-  to  five-minim  doses  suspended  in  mucilage,  every  three  hours, 
or  three  times  a  day,  without  inducing  any  unpleasant  effects,  not  even 
in  some  cases  causing  flushing,  whilst  other  patients  have  flushed  with 
each  dose,  but  only  whilst  swallowing  it. 

Dr.  Maraghano  uses  it  successfully  in  epilepsy.  He  raises  the  dose 
to  even  forty  drops,  and  says  the  inhalation  may  be  prolonged  forty 
minutes,  and  be  repeated  four  or  six  times  a  day.  He  gives  it  at  fixed 
times  of  the  day,  and  not  just  before  or  at  the  onset  of  an  attack.  In 
twenty-four  hours  1  to  3.5  grammes  of  sugar  appear  in  the  urine. 

The  patient  should  take  the  medicine  whilst  lying  down,  and  as  some 
patients,  especially  women,  are  very  readily  affected  by  the  drug,  it  is 
well  in  the  first  instance  to  give  it  in  smaller  doses ;  but  until  the  remedy 
is  pushed  to  two  and  in  some  cases  to  five  minims  every  three  hours,  I 
have  failed  to  obtain  conspicuous  results. 

Sir  Crichton  Browne  maintains  that  epileptics  are  more  sensitive 
than  others  to  inhalation  of  amyl.  I  imagine  that  this  medicine  will  be 
found  useful  only  in  frequent  attacks,  and  that  it  is  not  available  when 
the  fits  come  at  comparatively  long  intervals,  as  three  weeks  or  a  month. 

Inhalation  of  nitrite  of  amyl  has  been  recommended  in  sick  head- 
ache. 

Nitrite  of  amyl  is  useful  in  sea-sickness.  Nitrite  of  amyl  was  very 
useful  in  the  following  singular  case,  no  doubt  allied  to  sea-sickness. 
A  young  woman  could  not  travel  either  by  coach  or  train  without  suffer- 
ing great  sickness  and  headache  leading  to  considerable  exhaustion,  these 
symptoms  persisting  many  hours  after  the  journey.  Half  a  minim  of 
nitrite  of  amyl  dissolved  in  twenty  minims  of  spirit  and  a  drachm  of 
water,  taken  hourly,  almost  entirely  prevented  these  symptoms. 

I  have  used  this  remedy  extensively  with  considerable  success  in  cases 
of  tlic  following  kind :  A  woman,  perhaps  from  the  sudden  arrest  of  men- 


NITRITE    OF    AMYL,  297 

struation,  or  tlirough  depraved  health,  or  nervous  depression,  or  more  fre- 
quently at  the  change  of  life,  suffers  from  frequent  attacks  of  flushings 
or  "  heats "  starting  from  various  parts,  as  the  face,  epigastrium,  etc., 
thence  spreading  over  the  greater  part  of  the  body.  The  face,  and  even 
the  back  of  the  hands,  are  often  deeply  reddened,  the  veins  of  tlie  hands 
in  some  cases  dilating  to  double  the  previous  size.  Although  the  patient 
feels  deeply  flushed  sometimes  the  skin  remains  natural.  The  sensation 
of  heat  may  Ije  so  urgent  that  the  patient  opens  her  clothes,  or  removes 
the  greater  part  of  the  bed  covering,  and  even  throws  open  the  windoAV  in 
the  coldest  weather.  These  heats  may  last  a  few  minutes  only,  or  an  hour 
or  more,  and  may  be  repeated  many  times  a  day.  The}'  are  generally  fol- 
io ved  by  perspiration,  often  very  profuse,  at  other  times  the  skin  remains 
dry;  the  attacks  are  then  commonly  termed  "dry  heats,"  The  "heats" 
are  often  accompanied  by  great  throbbing  throughout  the  whole  body, 
followed  by  mucli  prostration,  the  patient  seeming  scarcely  able  to  rouse 
herself.  After  the  heats  pass  away  the  skin  sometimes  becomes  cold  and 
clammy,  and  may  turn  very  pale.  The  least  exertion  or  excitement  may 
hring  on  these  heats,  and  such  a  patient  generally  complains  of  cold  feet, 
and  sometimes  of  cold  hands.  The  flushings  are  occasionally  peculiarly 
and  abruptly  limited,  reaching  to  the  thighs,  knees,  or  elbows,  and  while 
all  the  parts  above  these  feel  burning  hot,  the  parts  below  feel  icy  cold. 
Sleep,  too,  is  often  much  broken,  the  patient  waking  with  frequent  starts, 
and  in  the  morning  feeling  unrefreshed.  Sometimes  they  occur  chiefly 
at  night.  In  many  cases  palpitation  or  "  flutterings  at  the  heart"  occur 
on  the  slightest  excitement,  or  even  without  apparent  cause. 

Nitrite  of  amyl  will  prevent  or  greatly  lessen  these  flushings  or  "heats," 
and  avert  the  profuse  perspiration,  throbljiug  of  vessels,  and  great  pros- 
tration. Sometimes  it  Avarms  the  feet  and  hands  and  controls  the  flutter- 
ing of  the  heart,  but  in  most  cases  it  fails  to  abate  these  symptoms,  and 
for  their  cure  other  remedies,  as  iron,  are  required,  Amyl  will  also  re- 
move the  giddiness,  confusion  of  mind,  heaviness  in  the  head,  and  even 
headache.     It  generally  produces  calm  refreshing  sleep. 

When  the  flushings  and  perspiration  are  slight,  this  remedy  is  scarcely 
needed ;  moreover,  the  perspirations  are  generally  considered  vicarious  and 
beneficial  at  the  change  of  life.  These  symptoms  in  many  cases  form 
only  a  minor  part  of  the  troubles  of  the  patient,  who  may  complain  of 
great  sinking  at  the  epigastrium,  or  severe  pains  in  different  parts  of  the 
body,  and  other  suffering  incident  to  this  period,  over  which  nitrite  of 
amyl  has  little  if  any  influence;  but  when  flushings  constitute  the  chief 
part  of  the  patient's  troubles,  this  medicine  is  most  serviceable. 

The  nitrite  of  amyl  in  ten  days  completely  cured  a  woman  who  for 
three  years  had  been  horribly  tormented  with  singular  attacks  repeated 
several  times  daily,  of  severe  burni]ig  sensation  over  the  loins,  whence  a 
glow  of  heat  spread  over  tlie  whole  body,  followed  by  perspiration,  the 
burning  sensation  being  so  unendurable  that  she  Avas  constrained  to  open 
the  wind OAV  at  night  cA'en  in  the  Avinter,  and  sometimes  to  rush  out  of 
doors. 

For  the  symptoms  just  described  I  have  generally  administered  this 
drug  by  the  stomach,  though  inhalation  ansAvers  as  Avell,  In  respect  of 
dose  it  must  be  borne  in  mind  that,  like  glonoine  (nitro-glycerine),  its 
effects  vary  greatly  Avith  different  persoiis,  one,  tAvo,  or  even  three  minims 
]n-oducing  in  some  only  flushings  of  the  face  and  slight  giddiness,  Avliile 
Avith  others  eA'en  a  dropAvill  induce  A'arious  disagreeable  SA^mptoms.     Thus 

3 


298  NITRO-fiLYCKRINE. 

one  woman  immediately  after  a  drop  dose  turned  deadly  pale,  felt  giddy, 
and  then  became  partially  unconscious,  remaining  so  for  ten  minutes. 
In  another  patient  the  same  dose  ])roduced  a  sensation  as  if  "a  vapor 
spread  from  the  throat  through  her  head,"  and  rendered  her  quite  power- 
less for  one  or  two  seconds.  A  third  of  a  minim  dose  sometimes  excites 
great  nausea,  or  a  tickling  in  the  throat;  and  one  delicate  woman,  after 
one-thirtieth  of  a  drop,  passed  for  a  few  minutes  after  each  dose  into  a 
trance-like  state,  everything  to  her  seeming  unreal,  and  the  breathing  1je- 
coming  rather  panting.  I  began  with  a  minim  dose,  but  was  obliged  to 
reduce  this  quantity,  and  ultimately  found  that,  for  the  most  part,  these 
patients  can  bear  one-third  of  a  minim  without  any  disagreeable  symp- 
toms, but  that  a  tenth,  nay,  even  a  thirtieth,  of  a  minim  will  in  some 
patients  counteract  the  flushing.  It  may  be  dissolved  in  rectified  spirit, 
two  minims  to  the  drachm,  and  of  this  the  dose  is  three  to  five  drops  on 
sugar  every  three  hours,  with  an  additional  dose  as  soon  as  the  flush  be- 
gins. Relief  generally  ensues  immediately,  but  sometimes  not  till  the 
medicine  has  been  taken  for  a  week.  As  the  patient  grows  accustomed 
to  the  remedy  the  dose  must  be  increased.  Dr.  Mary  Jacobi  finds  inhala- 
tion of  amyl  nitrite  useful  in  dysmenorrhoea.  In  a  case  where  two  ounces 
of  laudanum  had  produced  small  and  feeble  pulse,  infrequent  respirations, 
cyanosis,  nitrite  of  amyl  proved  very  useful.  Inhalation  of  nitrite  of  amyl 
immediately  improved  the  symptoms,  and  the  patient  ultimately  recov- 
ered. Dr.  Burroughs  reports  a  case  of  opium  poisoning,  where  nitro- 
glycerine proved  very  useful. 

Dr.  P.  A.  Walters  shows  that  nitrite  of  amy!  inhalation  influences  in 
no  way  the  urea,  uric  acid,  water,  nor  acidity  of  the  urine. 


NITRO-GLYCERINE. 

NiTRO-GLYCERiNE  is  a  trinitrite  of  glycerine.  Dr.  M.  Hay  holds  that 
it  is  decomposed  in  the  body,  other  alkaline  fluids  and  nascent  nitrous  acid 
being  liberated. 

Dr.  Murrell,  whilst  working  with  nitro-glycerine,  was  struck  by  the 
similarity  of  its  action  to  that  of  nitrite  of  amyl,  and  he  was  thus  led  to 
anticipate  that  nitro-glycerine  would  prove  iiseful  in  angina  pectoris. 

Twenty  years  ago,  Mr.  Field,  of  Brighton,  took  himself  two  minims  of 
a  one-per-cent.  solution.  In  three  minutes  he  experienced  a  sensation  of 
fulness  on  each  side  of  his  neck,  with  nausea,  and  for  a  moment  or  two 
some  mental  confusion.  He  heard  loud  rushing  noises  in  his  head,  and 
felt  constriction  round  the  lower  part  of  his  neck;  his  forehead  became 
bedewed  with  persj)iration,  and  he  yawned  frequently.  These  symptoms 
passed  away  in  aljout  half  an  hour,  but  were  followed  by  slight  headache, 
dull  heavy  pain  in  the  stomach,  with  a  sensation  of  sickness  without  vom- 
iting, lie  felt  for  some  hours  languid  and  disinclined  for  mental  or  phy- 
sical exertion,  and  the  headache  lasted  till  next  morning. 

Mr.  F.  A.  James,  of  University  College  Hos]Mtal,  also  tested  the  drug 
on  himself,  and  for  a  few  minutes  felt  as  if  intoxicated. 

Dr.  Murrell  made  a  large  number  of  observations  on  himself  and  on 
others  confirmatory  of  the  foregoing  statements.  After  taking  one  or  two 
minims  of  a  one-per-cent.  solution  he  feels  painful  pulstition  over  the 
whole  head,  the  pulsation  soon  affects  the  entire  body,  and  is  so  severe  that 
it  seems  to  shake  his  entire  frame,  and  is  so  marked  that  it  visibly  jerks  a  pen 


NITRO-GLYCERINE.  299 

held  in  his  hand.  The  pulsation  he  feels  to  his  fingers'  tips.  He  expe- 
riences a  sensation  of  fulness  over  his  whole  body.  Whilst  he  keeps  quiet 
these  symptoms  are  sliglit,  but  they  greatly  increase  on  movement,  and  the 
headache  is  intensified  on  stooping.  These  symptoms  last  about  five 
minutes,  to  be  followed  by  a  dull  aching  frontal  headache,  with  languor, 
depression,  and  inability  for  work.  He  never  feels  sick,  has  no  mental 
confusion  nor  giddiness.  His  sight  and  hearing  are  not  affected  till  about 
half  an  hour  after  taking  the  drug,  but  he  feels  drowsy.  The  headache 
lasts  till  next  day.  For  many  years  I  have  employed  this  substance,  and 
from  my  own  experience  can  confirm  all  the  foregoing  statements. 

In  numerous  observations  Dr.  Murrell  finds  that  the  symptoms  begin 
in  about  two  to  three  minutes  after  swallowing  the  medicine,  the  acute 
symptoms  lasting  about  ten  minutes,  whilst  headache  and  languor  persist 
about  four  to  five  hours. 

Though  the  drug  causes  a  glow  on  the  face,  accompanied  by  perspira- 
tion, still  it  only  very  slightly  flushes  the  face,  in  this  respect  differing 
from  nitrite  of  amyl.  Sometimes  nitro-glycerine  causes  very  free  perspi- 
ration. 

The  headache  is  at  first  throbbing,  and  felt  over  the  forehead,  some- 
times on  the  top  of  the  head,  sometimes  at  the  back.  The  continuous 
pain  is  dull  and  achiug.     Xausea  is  an  uncommon  symptom. 

It  increases  the  pulse  about  twenty  beats  per  minute.  The  acceleration 
begins  in  about  five  minutes  and  continu.es  half  an  hour.  The  pulse  be- 
comes full,  bounding,  large,  and  rather  soft,  but  never  intermittent  nor 
irregular.  The  pulse,  indeed,  manifests  the  characters  due  to  extreme 
arterial  relaxation. 

Dr.  Murrell  has  made  one  hundred  and  fifty  sphygmographic  tracings, 
and  has  compared  the  action  of  this  drug  on  the  same  person  many  times 
with  nitrite  of  amyl,  and  finds  that  nitro-glycerine  gives  a  similar  tracing 
to  nitrite  of  amyl.  The  amplitude  of  the  trace  is  much  increased,  the  rise 
and  fall  is  abrupt.  The  trace  displaj^s  marked  dicrotism.  Dr.  Murrell 
therefore  concludes  that  nitro-glycerine  causes  great  arterial  relaxation. 

The  effects  of  nitrite  of  amyl  come  on  sooner,  and  last  a  shorter  time, 
than  those  of  nitro-glycerine.  Thus,  the  effects  of  amyl  begin  in  fifteen 
seconds,  whilst  those  of  nitro-glycerine  are  delayed  for  five  minutes.  This 
difference  is  probably  due  to  the  great  volatility  of  nitrite  of  amyl. 

Nitro-glycerine,  in  medicinal  doses,  does  not  affect  the  temperature. 

Chemists  employed  in  preparing  nitro-glycerine  pills  on  a  large  scale 
complain  that  it  causes  sleeplessness. 

The  susceptibility  to  this  drug  varies.  One  or  two  minims  of  the  one- 
per-cent.  solution  affects  most  persons,  but  I  have  seen  even  half  a  minim 
greatly  affect  certain  patients,  and  to  such  an  extent  that  they  could  not 
continue  the  medicine. 

Dr.  ]\Iurrell  recommends  nitro-glycerine  in  angina  pectoris.  It  is  cer- 
tainly equal,  if  not  superior,  to  nitrite  of  amyl.  In  many  cases  it  is  cer- 
tainly superior.  I  have  seen  cases  where  the  relief  from  amyl  was  very 
transient,  but  much  more  persistent  from  nitro-glycerine.  In  some  case 
ayml  succeeds  best,  in  others  nitro-glycerine.  Nitro-glycerine  is  slower 
in  relieving  pain,  but  its  effects  are  often  more  prolonged.  They  should 
be  administered  differently.  Amyl  is  only  useful  when  given  during  a 
paroxysm.  ISTitro-glycerine  may  be  given  at  stated  intervals,  say  every 
two  or  three  hours,  and  an  additiojial  dose  on  the  onset  of  a  paroxysm. 
The  regular  administration  greatly  lessens  the  frequency  of  the  attacks. 


300  NITKITK    OF    SODIUM. 

Occasionally,  however,  it  jn-oduces  so  much  headache  that  patients  are 
obliged  to  desist  from  its  use.  In  one  case  it  at  first  afforded  much 
relief,  but  afterwards  each  dose  induced  a  slight  paroyxsm.  It  should 
be  given  in  jj^-g-min.  dose,  either  dissolved  in  water,  or  made  into  tablets, 
as  sold  by  Martindale.  One  of  my  patients  took  a  hundred  of  these 
tablets  a  day,  with  great  benefit. 

Nitro-glycerine  is  recommended  in  sea-sickness. 

Dr.  Neale  has  seen  it  of  great  service  in  the  paroxysms  of  asthma, 
and  in  migraine.  Speaking  of  a  case  of  asthma,  he  says,  "  the  tongue  of 
the  patient  was  touched  with  the  stopper  of  a  bottle  contianiug  a  5  per- 
cent, solution,  when  the  paroxysm  was  so  severe  as  to  cause  const^nation 
to  all  round,  and  in  less  than  a  minute  there  was  a  great  calm." 

It  has  been  long  used  in  migrainous  headaches,  and  in  many  cases, 
no  doubt,  it  is  very  efficacious,  though  it  fails  not  unfrequently..  I  give 
a  tablet  containing  y^jj  to  -^1^-  of  a  minim  every  hour  or  oftener  immedi- 
ately the  headache  begins.  Dr.  Hammond  gives  it  in  the  aparoxysmal 
period,  and  successfully,  to  avert  the  attacks.  Dr.  Hammond  also  gives 
nitro-glycerine  in  epilepsy  and  the  status  epilepticus.  It  sometimes  cures 
hiccough,  and,  like  nitrite  of  amyl,  it  averts  the  cold  stage  of  ague. 

Nitro-glycerine  is  employed  in  contracted  kidney  to  lower  arterial 
tension,  ancl  often  relieves  the  distressing  headache  of  Bright's  disease 
better  than  other  remedies.  It  is  said  to  increase  the  quantity  of  urine 
in  chronic  parenchymatous  nephritis.  Injected  into  the  jugular  vein 
nitro-glycerine  arrests  the  heart.  It  paralyzes  the  vagus  (Brunton). 
Like  other  nitrites,  it  affects  the  blood,  which  becomes  chocolate  colored. 
It  tetanizes,  and  then  paralyzes  frogs,  but  not  through  the  spinal  cord 
(Brunton).  It  directly  paralyzes  muscle.  It  destroys  the  reflex  func- 
tion of  the  cord,  and  death  takes  jjlace  from  asphyxia. 


NITRITE  OF  SODIUM. 

We  have  just  seen  how  similar  is  the  action  of  nitro-glycerine  to 
that  of  nitrite  of  amyl,  and  it  is  probable  that  all  nitrites  act  in  the  same 
way;  for  instance,  Dr.  Reichert,  Dr.  Mitchell,  and  Dr.  Matthew  Hny, 
find  that  nitrite  of  sodium  and  nitrite  of  potassium  act  just  like  nitro- 
glycerine and  nitrite  of  amyl.  Moreover,  in  the  preparation  of  nitrous 
ether,  the  workmen  suffer  from  symptoms  just  like  those  produced  by 
nitrite  of  amyl  and  nitrite  of  sodium. 

Dr.  Matthew  Hay  finds  that  nitrite  of  sodium  in  a  dose  of  five,  ten, 
or  twenty  grains  accelerates  the  pulse,  causes  throbbing,  and  a  sensation 
of  fullness  in  the  head  and  eyes,  with  slight  flushing  of  the  face.  The 
sensations  of  throbbing  and  fullness  last  an  hoar  or  more;  the  larger  the 
dose  the  longer  these  sensations  persist.  Gamgee,  too,  has  shown  that 
nitrite  of  soda  affects  the  blood  like  nitrite  of  amyl. 

Nitrite  of  sodium  frequently  acts  purgatively  on  rabbits  and  dogs, 
even  when  injected  subcutaneously,  and  it  reddens  and  inflames  the 
mucous  membrane.  It  is  useful  in  angina  pectoris.  I  find  it,  however, 
less  useful  than  nitro-glycerine  or  nitrite  of  amyl.  This  may  be  due  to 
the  rapidity  with  which  it  changes,  so  that  but  little  or  none  of  the 
nitrite  is  administered.  Its  instability  will  probably  prevent  its  coming 
into  use.     One  grain  repeated  several  times  a  day  is  an  efficient  dose. 

It  has  been  recommended  in  eiailepsy,  but  further  evidence  is  required 


CAMPHOR.  301 

to  prove  that  it  is  useful  for  the  graver  forms  of  this  obstinate  disease, 
though  I  have  certainly  lessened  the  frequency  of  attacks  of  petit  mal 
by  a  grain  dose,  given  twice  or  thrice  a  day. 

Lublinski  finds  it  useful  in  nervous  and  bronchial  asthma,  but  useless 
in  the  asthma  due  to  emphysema.  He  also  finds  it  very  useful  in  mi- 
graine. It  is  useful  in  the  asthma  of  Bright's  disease.  Like  nitrite  of 
amyl,  it  will  avert  the  cold  stage  of  ague. 

A  large  toxic  dose  causes  giddiness,  blueness  of  the  face  and  hands, 
fluttering  at  the  heart,  throbbing  pains  in  the  head,  sometimes  violent 
perspiration,  and  these  symptoms  may  continue  for  one  or  two  hours. 


CAMPHOR. 


At  the  temperature  of  the  body  camphor  is  solid,  but  it  slowly  volat- 
ilizes, even  at  a  lower  temperature.  But  little  soluble  in  water,  it  freely 
dissolves  in  oil  and  alcohol.  Camphor  destroys  most  plants,  except  those 
of  the  lowest  organizations,  as  the  fungus — commonly  called  mould.  It 
is  said  to  be  poisonous  to  fleas,  bugs,  spiders,  and  other  insects.  Cam- 
phor excites  redness  and  heat,  indeed  slight  inflammation,  in  the  un- 
broken skin,  and.  of  coiirse,  irritates  more  powerfully  wounds  and  deli- 
cate structures  like  mucous  membranes,  and  may  j^roduce  not  only  active 
inflammation,  but  even  slough  and  ulcers.  It  has  been  api^lied  to  stimu- 
late indolent  sores.  It  is  a  useful  addition  to  dusting  powders  to  allay 
the  heat,  tingling  and  itching  of  ezcema  and  intertrigo.  Camphor  is  a 
common  ingredient  of  tooth-powder,  and  is  a  corrective  of  foul  breath. 
It  is  largely  used  as  a  liniment  to  relieve  pain,  neuralgic,  myalgic  and 
•rheumatic;  also  to  sprains  and  to  joints  afflicted  with  chronic  rheumatism. 

Camphorated  alcohol  has  been  recommeiided  as  a  remedy  for  boils  at 
their  earliest  stages,  applied  three  times  a  day  for  half  a  minute,  after- 
wards letting  the  skin  dry,  and  then  smearing  it  with  camphorated  oil.  It 
is  said  that  a  few  applications  will  usually  disperse  the  coming  boil.  In- 
haled, or  taken  by  the  stomach,  camphor  exerts  a  decided  influence  on 
"  cold  in  the  head."  Employed  at  the  beginning  of  an  attack  (it  is  useless 
after  the  first  stage),  camphor  sometimes  arrests  an  ordinary  cold,  and, 
failing  this,  it  abates  its  violence,  obviating  or  diminishing  frontal  head- 
ache, and  restraining  the  sneezing  and  running  at  the  nose. 

Camphor  inhalations  are  sometimes  useful  in  that  troublesome  and 
chronic  complaint  characterized  by  seizures  of  incessant  sneezing,  and 
profuse  watery  running  at  the  eyes  and  nose,  the  patient  remaining  well 
in  the  intervals.  The  attacks  may  occur  daily,  beginning  early  in  the 
morning,  and  may  last  for  a  few  minutes  only,  or  persist  for  several  hours: 
and  they  may  occur  at  any  hour  of  the  day,  recurring  several  times  daily. 
Sometimes  several  days  intervene  between  the  attacks,  which  may  last 
twenty-four  hours,  or  even  longer.  They  are  generally  accompanied  by 
severe  frontal  headache,  and  in  some  instances  an  itching  of  a  point  inside 
the  nose  denotes  the  imminence  of  an  attack.  This  affection  lasts  for 
years. 

In  catarrh,  and  in  this  unnamed  affection,  the  patient  should  either 
sniff  up  finely-powdered  camphor,  or  inhale  by  the  nose  some  of  the  alco- 
holic solution  poured  on  a  handkerchief,  or  into  boiling  water;  but  when 
boiling  water  is  used  it  is  needful  to  protect  the  eyes  from  the  camphor 
vapor,  to  obviate  smarting  and  inflammation.     At  the  same  time  he  should 


302  CAMPHOR. 

take  four  to  six  drops  of  the  alcohol  solution  of  camphor  every  fifteen 
minutes  for  the  first  hour,  and  hourly  afterwards. 

For  drowsiness  or  headache  occurring  at  the  change  of  life,  or  from 
perverted  action  of  the  uterus,  Dr.  Tilt  orders  eau  de  Cologne  saturated 
with  camphor  to  be  rubbed  into  the  head.  A  lotion  of  equal  j)arts  of 
liquor  of  ammonia  and  spirits  of  camphor  dabbed  on  the  j^ainful  sur- 
face is  n  useful  application  for  the  heat  and  sensation  of  weight  at  the 
top  of  the  head,  so  frequent  at  the  change  of  life  or  from  menstrual  dis- 
turbance.    The  same  lotion  is  useful  in  migraine. 

Camphor  excites  in  the  mouth  and  stomach  a  sensation  of  coldness, 
followed  soon  by  a  sensation  of  warmth.  Large  doses  excite  epigastric 
pain,  nausea,  and  vomiting.  After  death  from  poisonous  doses  the 
stomach  and  intestines  are  found  reddened,  and  sometimes  even  ulcerated, 
the  amount  of  mischief  depending  on  the  mode  of  taking  the  camphor, 
which,  if  swallowed  in  solution,  quickly  passes  into  the  blood,  the  stomach 
being  but  little  affected;  but  if  swallowed  in  the  solid  form,  owing  to  its 
high  melting  point,  it  remains  long  enough  in  the  stomach  to  excite 
severe  inflammation,  and  most  of  it  escapes  undissolved  with  the  motions. 

Dr.  Bartholow  recommends  five  to  fifteen  minims  of  sjiirits  of  cam- 
phor for  flatulence,  especially  hysterical  flatulence,  and  for  flatulent  colic 
occurring  at  the  change  of  life. 

Few,  if  any,  remedies  are  comparable  to  camphor  in  summer  diar- 
rhoea and  cholera.  Its  benign  influence  in  cholera  is  most  conspicuous, 
for  it  generally  checks  the  vomiting  and  diarrhoea  immediately,  prevents 
cramp,  and  restores  warmth  to  the  extremities.  It  must  be  given  at 
the  very  commencement,  and  repeated  frequently,  otherwise  it  is  useless. 
Four  to  six  drops  of  strong  spirits  of  camphor  must  be  given  every  ten 
minutes  till  the  symptoms  abate,  and  hourly  afterwards.  It  is  a  good 
plan  to  mix  it  with  a  little  brandy,  but  it  acts  admirably  alone. 

Dr.  George  Bird  employs  spirit  of  camphor  with  good  results  in  the 
acute  dinrrhoea  of  infants,  and  where  admissible  gives  it  in  milk.  Cam- 
phor generally  restrains  the  diarrhoea  excited  by  the  effluvia  of  drains. 
Some  persons,  especially  women,  on  exposure  to  cold,  suffer  from  diar- 
rhoea, accompanied  with  severe  cutting  pains.  Standing  on  cold  objects 
is  especially  liable  to  excite  this  diarrhoea.  The  pain  may  be  very  severe, 
continuing  till  the  bowels  have  acted  three  or  four  times.  Camphor 
generally  relieves  the  pain,  and  restrains  this  diarrhoea. 

Camphor  readily  passes  into  the  blood,  and  manifests  itself  there, 
and  in  most  of  the  organs  of  the  body,  by  its  odor.  Its  influence  on  the 
blood  is  unknown.  Its  influence  on  the  heart  appears  to  be  capricious. 
Large  doses  often  slacken,  sometimes  quicken,  and  generally  weaken, 
the  j)ulse.  Moderate  doses,  it  is  said,  quicken  and  strengthen  the  pulse. 
Large  doses  sometimes  disturb  the  brain,  causing  at  first  increased 
activity,  with  a  rapid  flow  of  pleasant  ideas;  but  subsequently,  and  in 
some  cases  even  at  first,  camphor  produces  great  faintness,  giddiness, 
noises  in  the  ears,  much  delirium,  passing  sometimes,  like  alcoholic  in- 
toxication, into  drowsiness,  and  even  convulsions,  with  coldness  of  the 
surface,  shrunk  features,  and  clamminess  of  the  skin.  Large  doses  often 
induce  some  smarting  and  pain  of  the  urinary  organs,  with  urgent  desire 
to  pass  water. 

It  is  mainly  given  in  adynamic  fevers,  and,  according  to  Graves  and 
others,  it  is  a  very  valuable  remedy.  It  is  said  to  strengthen,  while  re- 
ducing the  frequency  of  the  pulse,  to  moisten  the  skin,  and  check  the 


TURPENTINE.  303 

deliriiim,  especially  when  of  a  low  and  muttering  character.  To  control 
delirium,  it  must  be  given  to  the  extent  of  twenty  grains,  or  more,  every 
two  or  tliree  hours,  and  its  eifects  must  be  watched.  Some  practical 
authorities,  however,  deny  the  efficacy  of  camphor  in  fever  delirium. 

It  has  also  been  recommended  in  melancholia,  in  spasmodic  affections, 
in  nervous  palpitation,  and  in  hiccup. 

It  is  rej^uted,  on  high  authority,  that  considerable  doses  of  camphor 
will  control  inordinate  sexual  desire.  It  is  said  to  relieve  strangury. 
Drachm  doses  of  the  sj)irit  will  relieve  chordee. 

Camphor  is  eliminated  by  the  breath,  probably  with  the  perspiration, 
and  a  small  proportion  with  the  urine.  The  irritation  it  produces  in 
the  urinary  mucous  membrane,  and  the  small  amount  of  camphor  sep- 
arated by  the  urine,  has  led  to  the  assumjjtion  that  some  of  the  products 
of  its  decomposition  in  the  body  escape  with  that  secretion,  ;ind,  in 
their  passage,  irritate  the  mucous  membrane;  but  on  this  point  nothing 
definite  is  known,  and  at  present  there  is  no  proof  that  camphor  is  con- 
sumed in  the  body. 


TUEPENTINE— OIL  OF  TURPENTINE. 

TuKPENTiNE  is  antiseptic.  Applied  to  the  skin  it  excites  a  sensa- 
tion of  warmth,  with  some  redness;  and,  if  the  application  is  sustained, 
blistering  takes  place.  It  is  in  common  use  as  a  rubefacient  and  counter- 
irritant.  Over  a  flannel  wrung  out  in  hot  water  some  turpentine  or 
turpentine  liniment  may  be  sprinkled,  and  applied  till  it  produces  red- 
ness, tingling,  and  smarting.  It  is  well  to  bear  in  mind  that,  as  the 
smarting  arising  from  the  application  of  a  turj)entine  stupe  goes  on 
augmenting  for  some  time  after  its  removal,  it  should  be  kept  on  no 
longer  than  just  sufficient  to  excite  a  moderate  degree  of  pain.  Turpen- 
tine stupes  may  be  employed  as  a  rubefacient  for  the  same  purposes  as 
a  mustard  poultice.  It  is  often  employed  in  the  form  of  liniment,  and 
is  useful  in  myalgia,  superficial  neuralgia  and  lumbago.  Turpentine 
liniment,  or  an  ointment  containing  turpentine,  is  useful  for  unbroken 
chilblains. 

Dr.  Faulis  employs  the  following  method  in  ringworm : — He  cuts  off 
the  hair  and  rubs  the  patch  with  turpentine  till  it  smarts.  He  then 
washes  it  well  with  carbolic  soap  (10  per  cent.).  The  smarting  soon 
ceases.  After  well  drying  the  skin,  he  paints  on  it  two  or  three  coats  of 
tincture  of  iodine.  Lastly,  he  anoints  the  hair  with  carbolic  oil  (1  in  20). 
He  claims  to  cure  the  worst  cases  in  a  week. 

Turpentine  in  the  stomach  excites  a  sensation  of  warmth,  and  large 
doses  sometimes  produce  nausea  and  vomiting.  It  generally,  but  not 
invariably,  acts  as  a  purgative;  and  if,  after  large  doses,  purgation  does 
not  take  place,  serious  symptoms  sometimes  arise  from  the  absorption 
of  the  turpentine,  and  from  its  action  on  the  organs  at  a  distance  from 
the  intestinal  canal.  Thus,  when  administered  in  considerable  doses,  it 
is  desirable  to  give,  either  simultaneously  or  soon  afterwards,  some  more 
active  and  certain  purgative,  as  castor-oil.  Even  after  large  doses  the 
stomach  and  intestines  of  animals  have  been  found  sometimes  free  from 
inflammation. 


304  TUKPENTINE. 

In  staying  hgemorrliage  from  the  stomach,  arising  from  chronic  ulcer, 
or  other  causes,  from  the  intestines  in  typhoid,  etc.,  few  remedies  are 
more  successful  than  turpentine  given  in  small  doses  of  five  to  ten  drops, 
very  frequently  rejieated.  Later  on  v/e  shall  speak  of  the  use  of 
turpentine  in  controlling  hajmorrhages  from  other  organs. 

Turpentine  proves  useful  in  certain  states  of  typhoid  fever,  probably 
from  its  direct  action  on  the  intestinal  mucous  coat.  Thus  Dr.  Wood 
has  drawn  attention  to  its  value  in  ten-minim  doses,  repeated  every  two 
hours,  when  the  tongue  parts  with  its  fur  in  flakes,  and  instead  of  be- 
coming and  remaining  moist,  looks  dry  and  glazed,  a  condition  usually 
observed  towards  the  end  of  the  disease,  and  accompanied  always  by  an 
increase  of  the  tympanites,  and  an  aggravation  of  the  other  symptoms. 
In  "  the  course  of  twenty-four,  or  at  most  forty-eight  hours,  some  ameli- 
oration of  the  symptoms  may  be  observed.  The  tongue  becomes  gradu- 
ally moister,  and  covers  itself  with  a  whitish  fur;  the  tympanitic  dis- 
tension ceases  to  augment,  and  after  a  time  diminishes;  the  pulse  be- 
comes less  frequent  and  the  skin  less  dry  and  harsh,  and  the  patient 
enters  slowly  but  regularly  into  convalescence,  often  without  any  other 
remedy.  As  the  case  improves,  the  quantity  of  the  oil  should  be  dimin- 
ished, but  care  should  be  taken  not  to  omit  it  too  hastily."  Dr.  Wood 
further  says,  "  I  will  repeat  that  oil  of  turpentine  may  be  used  with 
great  hope  of  benefit,  in  any  case  of  enteric  fever  in  the  advanced  stage, 
with  a  dry  tongue." 

Dr.  Graves  employed  it  in  the  same  disease,  in  drachm  doses  every 
six  hours  in  extreme  tympanites,  and  he  pointed  out  that  the  remedy  is 
of  no  use* if,  before  and  during  the  j^roduction  of  flatulent  distension 
there  is  diarrhoea,  when  acetate  of  lead  is  invaluable.  With  the  tympa- 
nites there  is  very  often  much  prostration,  with  muscular  trembling,  and 
picking  of  the  bed-clothes,  and  low,  muttering  delirium — symj^toms  all, 
according  to  Graves,  benefited  in  many  cases  by  the  use  of  turpentine. 

This  drug  is  successful  as  a  tape-worm  poison,  though  it  has  now 
given  place  to  milder  and  more  efficient  remedies.  Large  doses  of  half 
an  ounce  to  an  ounce  must  be  given,  and  should  be  combined  Avith  a 
purgative,  for  if  absorbed,  this  quantity  may  produce  disagreeable  symjD- 
toms.     A  smaller  dose  of  a  drachm  may  be  given  three  times  a  day. 

Turpentine  injected  into  the  rectum  will  destroy  thread-worms,  but 
many  other  substances  are  just  as  effective  vermicides. 

Turpentine  enemata  are  useful  in  flatulent  distension  of  the  bowels. 

Turpentine  may  be  inhaled  with  benefit  in  chronic  bronchitis,  but 
terebine  is  pleasanter  and  preferable. 

Turpentine  passes  readily  into  the  blood,  and  may  be  detected  in  the 
breath  and  sweat,  and  in  altered  st:ite  in  the  urine,  giving  to  this  ex- 
cretion an  odor  of  violets,  or  of  mignonette. 

In  large  quantities,  and  especially  if  it  fail  to  purge,  and  thus  escape 
promptly  by  the  rectum,  turpentine  produces  in  most  persons  some  ex- 
citement, with  giddiness,  confusion  of  siglit,  quickened  pulse,  and,  in 
extreme  cases,  insensibility,  with  dilated  pupils.  In  many  instances  it 
produces  bloody  and  scanty  urine;  or  indeed  it  may  suppress  this  secre- 
tion; occasionally  it  excites  pain  along  the  urinary  tract  with  frequent 
and  painful  micturition. 

Dr.  H.  A.  Ilare  shoAvs  that  moderate  doses  increase  the  frequency 
of  the  heart's  beats  from  direct  stimulation.  But  larger  doses  reduce 
the  frequency  by  stimulation  of  the  vagus  centre,     lie  finds,  too,  that 


TURPENTIlSrE.  305 

neither  large  nor  small  doses  have  much  effect  on  the  vaso-motor  system. 
In  small  closes  it  stimulates  the  whole  of  the  nervous  system,  the  brain 
first  and  most,  bat  large  doses  depress  this  system,  and  lessen  reflex  action. 

As  we  have  said,  it  is  very  etficacious  in  bleeding  from  the  various 
organs  of  the  body,  as  the  lungs,  nose,  uterus,  kidneys,  and  bladder.  A 
drachm  should  be  given  every  three  hours,  a  dose  which  sometimes 
causes  sickness,  diarrhoea,  and  even  blood  in  the  urine;  but  on  discon- 
tinuing the  drug  the  blood  soon  disappears.  Given  to  check  bleeding 
from  the  kidneys,  as  in  Bright's  disease,  it  must  be  administered  in  very 
small  quantities.  It  is  also  reputed  to  possess  the  power  of  checking 
bleeding  in  the  hgemorrhagic  diathesis,  and  to  be  useful  in  purpura.  , 

Large  doses  of  this  medicine  are  given  in  puerjoeral  fever,  but  author- 
ities are  divided  as  to  its  usefulness. 

According  to  some  authorities  it  has  been  employed  with  great  suc- 
cess in  sciatica,  in  half-ounce  doses,  given  for  four  or  eight  successive 
nights,  when,  if  it  fail  to  give  relief,  it  may  be  pronounced  useless  in 
that  particular  case. 

Dr.  George  Bird  finds  that  in  20-drop  doses,  thrice  daily,  it  is 
markedly  serviceable  in  lumbago.  Sjiirits  of  turpentine,  in  half-drachm 
doses,  several  times  daily,  is  very  useful  in  non-specific  choroiditis. 

Turpentine  is  an  antidote  to  phosiahorus,  and  Dr.  Letheby  says  that 
at  a  lucifer-match  factory  at  Stafford  the  workmen  prevent  necrosis  of 
the  jaw  by  w^earing  near  their  breast  a  small  oi^en  vessel  containing 
turpentine. 

The  experiments  of  Personne  on  fifteen  dogs  support  this  view.  To 
five  dogs  he  gave  phosphorus  alone,  and  they  all  died.  To  five  others, 
an  hour  or  two  after  the  phosi^horus,  he  gave  turpentine,  and  one  only 
died.  To  five  others  he  gave  tur^oentine  immediately  after  the  phos- 
phorus, and  only  one  dog  died.  These  experiments,  however,  are  not  so 
satisfactory  as  they  easily  might  have  been,  as  he  does  not  ajipear  to  have 
given  an  identical  dose  of  phosphorus  in  all  his  experiments.  Personne 
thinks  that  phosphorus  produces  asphyxia  by  becoming  oxidized,  and 
abstracting  oxygen  from  the  blood.  Pyrogallic  acid  absorbs  oxygen  from 
the  blood,  and  Personne  asserts  that  it  produces  the  same  symptoms 
and  post-mortem  appearances  in  dogs  as  phosphorus.  He  thinks  that 
turpentine  prevents  the  oxidation  of  ^ihosphorus,  so  that  it  is  eliminated 
unchanged  without  inflicting  injury  on  the  body. 

Kohler  confirms  Personne's  statement  of  the  antidotal  power  of 
turpentine,  but  controverts  his  explanation  of  its  action.  He  gave 
twenty-five  animals  from  0.006  to  0.09  grm.  of  phosphorus,  and  4,5 
grms.  of  turpentine,  and  on  killing  the  animals  the  tissues  showed  no 
fatty  degeneration,  or  other  signs  of  phosphorus  poisoning.  Kohler  says 
that  a  compound  of  phosphorus  and  turpentine  is  formed,  which  is 
eliminated  through  the  kidneys,  giving  to  the  urine  a  smell  like  opodel- 
doc, and  not  of  violets. 

Some  experimenters  deny  the  antidotal  virtue  of  turpentine.  These 
contradictory  statements  are  now  recoiiciled  by  the  observations  of 
Jonas,  who  finds  that  pure  turpentine  has  no  effect  on  phosphoi'us, 
whilst  French  turpentine  forms  a  spermaceti  crystalline  mass — turpen- 
tine-phosphoric acid,  which  is  said  to  be  harmless  and  to  be  eliminated 
by  the  kidneys  unchanged.  Experiments  with  the  different  kinds  of 
turpentine  as  antidotes  to  phosphorus  confirm  these  conclusions.  The 
French  turpentine  must  be  old  when  it  contains  ozone. 
30 


306 


VOLATILE    OILS. 


Turpentine  is  reputed  to  be  diuretic,  and  is  sometimes  administered 

in  small  doses  with  this  intent  in  Bright's  disease. 

It  has  been  used  in  chronic  cystitis,  in  gonorrhoea,  and  in  gleet. 

It  has  been  given  with  apparent  advantage  in  Ijiliary  colic. 

It  is  excreted  by  the  lungs  and  skin,  but  chiefly  by  the  urine,  giving 
it  the  odor  of  violets. 


Group  containing: — 
NUTMEGS. 
CLOVES. 

CANELLA  BARK. 
CINNAMON  BARK. 
CAJEPUT  OIL. 
OIL  OE  ANISE. 
FENNEL  FRUIT. 
CARAWAY  FRUIT. 
CORIANDER  FRUIT. 
DILL  FRUIT. 
ELDER  FLOWERS. 
LAVENDER  OIL. 
OIL  OF  ROSEMARY. 
OIL  OF  SANDAL  WOOD. 
MENTHOL. 


OIL  OF  PEPPERMINT. 

OIL  OF  SPEARMINT. 

OIL  OF  RUE. 

OIL  OF  LEMONS. 

CUBEBS. 

BUCHU  LEAVES. 

BALSAM  OF  TOLU. 

BALSAM  OF  PERU. 

COPAIBA. 

MEZEREON. 

SASSAFRAS. 

STORAX. 

JUNIPER. 

BENZOIN, 

Etc. 


This  group  consists  of  volatile  oils,  or  substances  containing  volatile 
oils.     Some  of  the  members  containing  a  bitter  constituent  are  tonics. 

The  ethereal  oils  penetrate  the  cuticle,  and  excite  slight  inflamma- 
tion. Some  are  employed  as  rubefacients  to  rheumatic  and  gouty  joints, 
to  the  face  in  toothache,  etc.  Dr.  Alfred  Wright,  of  Finchle}',  says  that 
in  China  he  learned  from  the  natives  the  practice  of  painting  oil  of 
pepi^ermint  on  the  face  in  facial  neuralgia.  He  uses  it  also  for  gout, 
the  relief  it  gives  in  both  instances  being  almost  instantaneous. 

There  is  a  German  quack  anti- neuralgic  liniment  Avliich  consists 
chiefly  of  oil  of  peppermint.  Balsam  of  Peru  is  a  useful  adjunct  to 
ointment  for  broken  chilblains.  Dr.  Robertson,  of  Cheltenham,  strongly 
recommends  the  local  application  of  cajejaut  oil  for  chilblains,  stating 
that  sometimes  one  application  will  effect  a  cure  (vide  Iodine).  Dr. 
Copland,  in  his  Dictionary,  states  that  in  the  form  of  ointment,  for 
which  he  gives  a  formula,  it  stimulates  the  growth  of  the  hair. 

All  essential  oils  destroy  lice,  whether  situated  on  the  head,  trunk, 
or  pubis;  but  in  ''  louse  disease  "  oil  of  rosemary  and  powdered  pyrethrum 
are  generally  preferred. 

Many  excellent  auihorities  extol  storax  and  Peruvian  balsam  in  itch. 
The  following  prei^arations  are  very  useful: — Storax,  an  ounce;  olive 
oil,  two  drachms.  Or,  rectified  spirit,  two  drachms:  storax,  an  ounce; 
olive  oil,  a  drachm;  mix  the  first  two  ingredients,  and  add  the  olive  oil 
to  them.  The  whole  body,  except  the  head,  is  carefully  rubbed  with 
either  compound.  One  application,  it  is  said,  kills  the  insects;  but,  to 
avoid  the  risk  of  failure,  it  is  better  to  repeat  the  application  in  twelve 
or  twenty-four  hours.  These  applications  cause  no  irritation  of  the  skin, 
and  they  possess  the  additional  advantage  of  an  agreeable  odor.     Al- 


VOLATILE    OILS.  307 

though  not  necessary  to  the  success  of  this  treatment,  yet  for  the  sake 
of  cleanliness,  a  warm  bath  should  be  given  before  and  after  the  inunc- 
tions. 

Dr.  McCall  Anderson  recommends  storax  highly,  asserting  that  it  is 
as  efficacious  as  sulphur,  while,  unlike  sulphur,  instead  of  irritating  it 
soothes  the  skin. 

Compound  tincture  of  benzoin  painted  on  the  skin,  or  mixed  with 
water,  Avill  sometimes  allay  itching  from  urticaria,  eczema,  etc.  Five  to 
:^fteen  grains  of  menthol  to  an  ounce  of  simple  ointment  is  very  useful 
in  ]»ruritus  ani,  and  to  a  less  extent  in  the  itching  of  eczema. 

The  stronger  prejiaration  may  produce  much  smarting,  therefore  the 
weaker  preparation  should -be  first  tried.  This  ointment  is  often  suc- 
cessful where  calomel  ointment  fails.  Dr.  Selwyn  Kussell  finds  that 
cutaneous  inflammations,  like  boils,  carbuncles,  excessive  inflammation 
following  vaccination,  are  speedily  relieved  by  painting  the  inflamed 
tissue  several  times  a  day  with  a  ten  to  fifty  per  cent,  solution  of  menthol 
in  ether  or  alcohol. 

A  piece  of  cotton  wool  saturated  with  a  ten  per  cent,  solution  of 
menthol  inserted  into  each  nostril  at  the  beginning  of  an  attack  of  coryza 
directly  itching  and  sneezing  begin,  and  allowed  to  remain  for  four  or 
five  hours,  is  said  to  cure  a  cold  in  the  head. 

Benzoic  acid  dissolved  in  spirits  or  eau  de  Cologne  is  also  very  useful 
in  urticaria;  a  drachm  added  to  boiling  water,  and  used  as  an  inhalation 
night  and  morning,  is  often  used  in  bronchitis,  and  even  in  chronic 
phthisis — easing  cough  and  lessening  expectoration. 

Terebine  is  a  useful  inhalent;  for  chronic  bronchitis  ten  minims 
should  be  used  in  boiling  water,  or  dropped  on  a  handkerchief  and 
placed  near  or  over  the  mouth. 

The  members  of  this  group  have  a  warm,  and  many  of  them  an 
agreeable  taste.  Oil  of  peppermint,  orange-flower  water,  oil  of  cinna- 
mon, oil  of  lemons,  conceal  the  flavor  of  disagreeable  medicines. 

These  oils  excite  a  sensation  of  warmth  in  the  stomach;  some  of 
them  being  used  to  increase  appetite  and  digestion.  In  large  doses  they 
excite  slight  inflammation  of  the  stomach  and  intestines.  Many  of 
them,  as  oil  of  cloves,  oil  of  cinnamon,  oil  of  anise,  oil  of  fennel,  oil  of 
coriander,  oil  of  caraway,  oil  of  pei^permint,  are  employed  to  prevent  the 
griping  pains  of  purgative  medicines. 

Some,  as  cloves  and  cinnamon,  are  useful  in  diarrhoea  as  adjuncts  to 
astringents.  Their  stimulant  action  on  the  muscular  coat  of  the  stomach 
and  intestines  removes  colic  and  expels  wind;  oil  of  cajeput  especially, 
and  oil  of  cloves,  are  generally  preferred  in  flatulence.  Spirits  of  horse- 
radish, in  half-drachm  to  drachm  doses,  is  highly  approved  in  flatulence. 
Cajeput  oil  is  said  to  relieve  the  pain  of  dysmenorrhsea. 

These  oils  probably  pass  readily  into  the  blood,  and  for  the  most  part 
act  like  turpentine.  Many  of  them  are  employed  as  antispasmodics, 
but  they  are  inferior  in  this  respect  to  chloroform  and  ether.  Whether 
they  undergo  any  changes  in  the  blood  is  at  present  unknown. 

Balsam  of  Tolu  and  balsam  of  Peru,  and  copaiba,  are  given  in  chronic 
bronchitis  with  a  copious  secretion  of  pus. 

Mezereon  and  sassafras  are  reputed  to  be  useful  in  syphilis  and  chronic 
rheumatism. 

Lavender,  rosemary,  rue,  cinnamon,  and  some  other  members  of  this 
group  are  given  as  stimulants  to  nervous  and  hysterical  persons  affected 


oQg  VOLATILE     OILS. 

with  depression  of  spirits  and  other  symptoms;  but  they  soon  lose  their 
effect,  unless  given  in  increased  doses.  Drachm  doses  of  oil  of  cinna- 
mon, given  several  times  daily,  is  strongly  recommended  in  menorrhagia 
and  flooding. 

Senator  finds  benzoic  acid,  150  to  180  grains  daily,  useful  in  acute 
rheumatism,  though  inferior  to  salicylic  acid. 

These  oils,  and  the  resins  derived  from  them,  escape  from  the  body 
in  jjart  with  the  breath  and  perspiration,  but  chiefly  with  the  urine,  and 
in  their  passage  along  the  urinary  tract  they  stimluate  or  irritate  i^ 
mucous  membrane.  Copaiba  sometimes  causes  bloody  urine  with 
strangury  and  pain  in  the  bladder. 

I  know  of  no  remedy  so  useful  in  chronic  cystitis  as  pereira.  Two 
to  three  drachms  of  the  liquid  extract  every  three  or  four  hours  speedily 
reduces  the  amount  of  blood  in  the  urine,  and  more  slowly  reduces  the 
pus  and  mucus.     At  the  same  time  it  often  promotes  appetite. 

Copaiba,  cubebs,  and  especially  buchu,  are  commonly  used  in  chronic 
inflammation  of  the  bladder  and  urethia. 

Half  drachm  or  drachm  doses  of  tincture  of  cubebs  in  half  a  tumbler 
of  linseed  tea  thrice  daily  are  very  useful  in  coughs  due  to  chronic 
catarrh,  or  those  following  influenza,  or  a  simple  acute  catarrh,  or  in 
the  cough  of  emphysematous  patients.  It  often  cures  the  cough  "like 
a  charm." 

Copaiba  and  cubebs  are  used  in  gonorrhoea  and  gleet,  and  cubebs 
often  succeeds  when  copaiba  fails.  Copaiba  beneflts,  it  is  said,  the 
chronic,  but  aggravates  the  acute,  stages  of  gonorrhoea;  while  cubebs, 
which  must  be  give  in  large  doses,  is  considered  only  useful  at  the  com- 
mencement of  attack.  Copaiba,  however,  often  promptly  relieves  an 
acute  attack.  Emulsified  copaiba  has  been  used,  especially  for  women, 
as  an  injection  for  gonorrhoea. 

Balsam  of  copaiba,  in  ten  to  fifteen  minim  doses,  sometimes  acts  as 
a  powerful  diuretic,  and  Dr.  Wilks,  wdio  used  it  with  much  success,  finds 
that  the  diuretic  properties  reside  in  the  resin.  Copaiba  has  been  found 
very  useful  in  some  cases  of  ascites,  entirely  removing  the  abdominal 
dropsy,  and  in  Bright's  disease.  I  have  in  many  cases  used  the  resin  in 
ten  to  fifteen  grain  doses,  often  with  great  effect;  I  have  seen  it  answer 
in  cardiac  dropsy  and  in  ascites,  where  the  kidneys  were  healthy ;  also 
in  ascites  where  there  was  fatty  degeneration  of  the  kidneys ;  and  in 
Bright's  disease,  where  the  kidneys  seemed  the  seat  of  fibroid  change 
and  fatty  degeneration,  being  much  contracted,  granular,  red,  firm,  the 
cortex  much  contracted,  with  numerous  small,  opaque,  buff-colored  spots. 
I  have  also  seen  it  remove,  speedily  and  entirely,  extensive  dropsy,  due 
probably  to  pale  fatty  kidney.  I  have  also  known  the  resin  benefit  the 
chronic  diseases  loft  by  an  attack  of  acute  liright's  disease,  and  prevail 
over  a  case  of  cardiac  dropsy,  with  a  small  amount  of  albumen  in  the 
urine,  and  wntli  signs  of  general  decay.  Yet  in  cases  which  appear  ex- 
actly similar  I  have  known  it  to  fail  entirely,  leading  me  to  think  that 
success  or  failure  depends  less  on  the  nature  of  the  disease  than  on  some 
individual  peculiarity.  In  some  cases  copaiba  causes  bloody  urine,  in 
others  I  have  seen  a  large  amount  of  blood  in  the  urine  quickly  disap- 
pear under  the  influence  of  copaiba  resin. 

Copaiba  occasioiially  produces  a  rash,  sometimes  like  urticaria,  some- 
times very  closely  simulating  the  papules  of  measles,  but  there  is  no  fever 
with  copaiba  rash.     If  the  medicine  is  continued,  the  papules  last  many 


fl 


EUCALYPTUS.  309 

days.  The  rash  does  not  begin  on  the  face,  then  spreading  downwards 
over  the  body,  but  is  patchy,  and  shows  a  preference  for  the  neighbor- 
hood of  joints.  In  doubtful  cases,  where  j^atients  deny  that  they  have 
taken  copaiba,  it  may  be  detected  in  the  urine  by  the  smell,  and  with 
still  greater  certainty  by  chemical  reagents;  for,  if  copaiba  is  present, 
nitric  acid  makes  the  urine  turbid,  which  heat  dispels.  Copaiba  may 
also  be  extracted  from  the  urine  by  shaking  it  up  with  ether. 

Oil  of  sandal-wood,  in  doses  of  fifteen  minims  three  times  a  day,  is 
useful  in  acute  and  chronic  gonorrhoea. 

Probably  most  of  these  ethereal  oils  escape  from  the  body  with  the 
urine;  but,  from  Weikart's  experiments,  quoted  by  Parkes,  this  does  not 
appear  to  be  the  case  with  copaiba,  the  volatile  oil  being  destroyed  in 
the  body,  and  only  its  resinous  acid  appearing  in  the  urine. 

Many  persons  highly  esteem  juniper  as  a  diuretic  in  scarlatinal 
dropsy. 

Many  of  these  oils  may  be  prescribed  in  capsules. 


EUCALYPTUS. 


EucALTPTOL  destroys  the  lower  forms  of  life  and  is  a  powerful  an- 
tiseiDtic  and  disinfectant.  It  is  more  antiseptic  than  quinine;  and  this 
jDroperty  increases  with  its  age,  when  it  contains  more  oxygen.  It  arrests 
the  amoeboid  movements  of  white  corpuscles.  When  applied  to  the 
skin  and  its  evaporation  is  prevented,  it  excites  redness,  and  even  vesi- 
cation. 

Mixed  with  iodoform  it  is  a  useful  application  in  chancrous  sores  and 
hard  chancres ;  and  with  iodoform  and  vaseline  is  sometimes  very  useful 
in  the  dry  stage  of  eczema. 

Eucalyptus  and  its  oil  have  a  warm  camphoraceous  taste,  and  increase 
the  salivary  and  intestinal  secretions,  producing  copious  and  soft  motions, 
whilst  large  doses  excite  diarrhoea,  and  the  stools  smell  of  eucalyptol. 
The  active  principles  are  readily  dissolved.  It  is  often  employed  topically 
in  diphtheria,  the  oil  being  applied  to  the  throat  and  also  used  as  an  in- 
halation. 

Twenty  drops  inhaled  several  times  a  day  with  an  oronasal  inhaler 
often  relieve  cough  in  chronic  bronchitis  and  chronic  phthisis.  In  most 
cases  it  is  decidedly  inferior  to  creasote,  but  it  sometimes  succeeds  where 
creasote  fails,  and  may  be  employed  where  the  taste  of  creasote  cannot 
be  tolerated. 

It  excites  perspiration. 

Preparations  of  eucalyptus  are  given  in  atonic  dyspepsia,  chronic 
gastric  and  intestinal  catarrh,  and  in  vomiting  from  sarcins.  Eucalyp- 
tol is  used  as  an  injection  for  thread-worms.  It  is  given  in  the  various 
symptoms  connected  with  the  change  of  life,  as  flatulence,  palpitation, 
flushings.  It  is  used  in  the  form  of  cigarette  in  asthma,  and  is  highly 
commended  in  chronic  bronchial  catarrh  and  bronchorrhoea,  and  in 
chronic  catarrh  of  the  genito-urinary  tract.     It  contracts  the  spleen.  _ 

In  large  doses  eucalyptol  acts  on  the  kidneys  like  turpentine,  copaiba, 
and  cubebs,  and,  like  these  drugs,  it  is  useful  in  small  doses  _  in  acute 
and  chronic  nephritis.  Eucalyptol  is  highly  praised  in  chronic  inflam- 
mation of  the  bladder. 


310  ASSAFCETIDA AM.A[ONIACUM GALBANU.M. 

lu  toxic  doses  it  probably  depresses  the  spinal  cord,  the  brain,  medulla 
oblongata,  and  heart,  and  so  induces  drowsiness,  shallow  breathing  and 
lowered  arterial  tension.     It  kills  by  arresting  respiration. 

It  is  used  in  intermittent  fever,  but  in  most  cases  it  is  undoubtedly 
much  inferior  to  quinine. 

The  active  principles  are  eliminated  by  the  skin,  the  bronchial  mucous 
membrane  and  the  kidneys. 


VALERIAS".     VALERIANATE  OF  ZINC.     VALERIAXATE    OF 
QUINIA.     VALERIAXATE  OF  AMMONIA. 

Like  turpentine  and  the  volatile  oils,  valerian  produces  a  sensation 
of  warmth  in  the  stomach,  a  quickened  pulse,  some  mental  excitement, 
and,  in  a  large  dose,  even  delirum. 

Neligan  considers  valerian  a  powerful  anthelmintic,  and  especially 
recommends  it  when  the  worms  excite  convulsions. 

Valerianate  of  zinc  is  very  useful  for  those  numerous,  distressing 
and  changeable  symptoms  included  under  hysteria,  generally  occurring 
in  women  at  the  menopause.  Thus  it  will  ordinarily  remove  "flush- 
ings of  the  face,"  "  hot  and  cold  perspirations,"  restlessness,  nervousness, 
depression  of  sj^irits,  sensation  of  suffocation  in  the  throat,  throbbing  of 
the  temples,  fluttering  at  the  heart,  heat  and  Aveight  on  the  top  of  the 
head.  In  many  instances  these  symptoms  depend  on  uterine  derange- 
ments, piles,  dyspepsia,  or  constipation;  but,  after  the  removal  of  all 
discoverable  diseases,  or  in  cases  where  no  cause  for  the  symptoms  can 
be  detected,  valerianate  of  zinc  is  often  very  beneficial.  Oxide  of  zinc 
does  good,  but  is  certainly  inferior  to  the  valerianate.  In  many  instances, 
however,  valerianate  of  zinc  fails  in  the  very  cases  we  should  exj)ect  it 
to  be  useful,  our  knowledge  of  the  conditions  indicating  the  employ- 
ment of  these  medicines  being  at  present  not  sufficiently  precise  to 
enable  us  to  predict  the  cases  in  which  they  will  be  likely  to  succeed.  It 
should  be  given  in  three-  to  five-grain  doses  in  a  silvered  or  coated  pill. 

Some  prefer  valerian  or  its  tincture,  and  ascribe  most  of  its  efficacy 
to  the  volatile  oil,  others  prefer  the  salts  of  valerianic  acid. 

Valerian  has  been  used  with  occasional  advantage  in  epilepsy,  but 
whether  in  true  epileps}-,  or  in  the  merely  hysterical  form  of  the  disease, 
does  not  appear. 

Valerianate  of  zinc,  or  valerianate  of  ammonia,  in  twenty-grain  doses, 
sometimes  relieves  neuralgia  of  the  face  or  head.  It  is  recommended 
in  megrim  in  doses  of  from  two  to  five  grains  thrice  daily.  It  is  said 
that  valerian  preparations  will  control  the  paroxysms  of  whooping- 
cough,  and  the  involuntary  movements  of  chorea.  Large  and  increas- 
ing doses  of  valerian  are  stated  to  be  useful  in  diabetes  insij^idus. 


ASSAFCETIDA.     AM^^EONIACUM.  •  GALBANUM. 

These  medicines  act  very  similarly  on  the  body;  but  assafoetida, 
prob:iblv  because  it  contains  most  volatile  oil,  is  the  most  2')owerful. 

Assafcetida  has  a  warm  and  disagreeable  characteristic  taste;  it 
stimulates  the  stomach  and  intestines,  expels  wind,  and  in  large  doses  it 


CANTIIAKIDES.  311 

often  excites  nausea  and  vomiting.  It  increases  the  secretion  from  the 
mucous  membrane  of  the  intestines,  and  hence  acts  as  a  mild  purgative. 
Probibly  the  active  principles  of  these  drugs  do  not  pass  quickly  into 
the  blood;  for  they  make  the  eructations  offensive  for  twenty-four  hours, 
or  longer. 

They  generally  quicken,  but  sometimes  slacken,  the  pulse. 

A  full  dose  of  assafoetida  induces  general  exhilaration,  and  sometimes 
"  various  nervous  or  hysterical  phenomena,  and  a  general  sense  of 
vudaise  "  (Jorg).     It  often  produces  headache  and  giddiness. 

It  is  said  to  increase  the  bronchial  secretions  and  perspiration.  It 
does  not  similarly  affect  all  persons,  since  Pidoux  took  enormous  doses 
without  experiencing  any  inconvenience,  except  from  the  offensive  smell 
of  his  ftBces. 

Assafffitida  is  very  useful  in  hysteria,  in  many  cases  removing  hysteri- 
cal headache  and  peculiar  sensations  in  the  head.  It  is  also  useful  in 
hysterical  flatulence. 

Assafoetida  is  useful  in  the  flatulence  of  young  children,  unconnected 
with  constipation  or  diarrhoea.  A  teaspoonful  every  hour  of  a  mixture 
containing  a  drachm  of  the  tincture  to  half  a  piut  of  water  is  readily 
taken  by  children,  and  is  strong  enough  to  speedily  relieve  distension. 
When  the  flatulence  is  due  to  constipation  or  diarrhoea,  assafoetida  does 
very  little  good. 

Assafcfitida  has  been  recommended  in  asthma.  All  members  of  this 
group  are  useful  in  chronic  bronchitis,  with  much  wheezing  and  abun- 
dant discharge,  symptoms  commonly  met  with  in  elderly  people,  but  in 
cases  like  these,  ammoniacum  is  generally  preferred  to  assafoetida. 


CANTHARIDES.     {See  Counter-irritation.) 

Preparations  of  cantharides,  taken  internally,  produce  an  un- 
pleasant burning  taste,  and,  if  in  a  large  quantity,  inflammation  and 
vesication  of  the  mouth. 

The  effect  of  cantharides  in  the  stomach  is  in  all  respects  similar  to 
that  in  the  mouth.  Even  small  doses  cause  smarting  in  the  oesophagus, 
pharynx,  and  stomach;  but  a  larger  quantity  produces  inflammation  of 
these  parts,  and  of  the  intestines,  with  vomiting,  and  diarrhoea  of  bloody 
and  slimy  stools,  much  pain  and  difficulty  in  swallowing,  and  often 
general  peritonitis,  with  which  the  system  sympathizes,  as  indicated  by 
high  temperature  and  quick  pulse. 

The  active  principle  of  cantharides  passes  from  the  stomach  and  in- 
testines into  the  blood.  Its  passage,  it  is  true,  has  not  been  chemically 
demonstrated,  but  the  symptoms  following  the  administration  of  this 
drug  renders  this  conclusion  certain;  for,  after  a  large  dose,  all  the  in- 
dications of  acute  inflammation  of  the  kidneys  set  in,  with  much  irrita- 
tion or  even  inflammation  of  the  urinary  and  generative  organs,  and,  after 
a  poisonous  dose,  headache,  loss  of  sensibility,  convulsions,  and  death. 

The  changes  cantharidine  in'oduces  in  the  blood  are  at  present  un- 
known. 

The  tincture  or  powder  used  to  be  given  in  cholera  and  epilepsy,  but 
this  treatment  has  now  fallen  into  complete  disuse. 

Little  is  known  of  the  separation  of  the  cantharidine  from  the  body. 


312  CANTHARIDES. 

It  is  conjectured  that,  being  volatile,  some  may  pass  off  by  the  lung?; 
but,  if  so,  it  produces,  apparently,  in  its  transit  through  the  lungs,  no 
changes  in  the  mucous  membrane  of  the  air-passages.  Owing  to  the 
same  property,  some  of  the  cantharidine  probably  passes  off  by  the  skin; 
and  the  internal  use  of  preparations  of  Spanish-fly  are  recommended  by 
several  eminent  French  dermatologists  in  psoriasis,  eczema,  lichen,  and 
prurigo.  The  chief  portion  of  the  active  j^rinciples  of  cantharides  escape 
by  the  kidneys,  and,  as  we  have  said,  acts  as  a  strong  irritant  to  the 
urinary  and  sexual  organs.  It  may,  like  oil  of  mustard,  turj)entine,  or 
copaiba,  produce  hyperaemia  of  the  kidneys,  with  bloody  urine,  which 
may  partially  set  into  a  jelly  from  the  fibrine  it  contains.  This  coagula- 
tion is  said  to  be  characteristic  of  congestion  produced  by  these  and 
allied  substances.  Camphor,  in  two  to  five  grains,  is  said  to  remove 
jjromptly  this  hyperaemia. 

The  preparations  of  cantharides  have  been  recommended  on  high 
authority  in  certain  forms  of  Bright's  disease,  but  this  drug  has  for  years 
past  been  regarded  as  a  most  dangerous  dug  in  this  disease. 

The  discrepancy  respecting  the  effects  of  cantharides  arises,  perhaps, 
from  the  difference  in  the  dose  administered  by  various  observers.  I  am 
convinced  of  its  usefulness  in  acute  Bright's  disease,  when  the  active 
inflammation  and  fever  have  subsided,  as  they  invariably  do  about  the 
fifth  to  the  eighth  day.  A  chronic  state  often  follows  the  subsidence  of 
the  more  acute  stage,  and  the  urine  continues  small  in  quantity,  contains 
albumen,  and  perhaps  blood.  If,  just  at  this  time,  that  is,  on  the  im- 
mediate subsidence  of  the  acute  inflammation,  a  one-  to  three-minim  dose 
of  tincture  of  cantharides  is  given  every  three  hours,  the  blood  will 
almost  always  quickly  disappear,  wdiile  the  albumen  decreases  more 
gradually,  and  the  urine  becomes  more  abundant.  At  a  crisis  like  this, 
it  is  true  that  a  like  amendment  not  unfreqaently  takes  place  without 
any  treatment;  but  the  influence  of  the  cantharides  can  often  be  put  to 
a  conclusive  test.  To  a  patient  in  the  condition  described  above,  pass- 
ing urine  containing  albumen  and  much  blood,  give  the  drug  in  the  way 
l^ointed  out,  and  he  wull  begin  to  improve;  now  withhold  the  medicine, 
and  both  blood  and  albumen  return  in  their  original  quantity,  and  both 
may  be  augmented  and  lessened  again  and  again  by  intermitting  and 
reverting  to  the  cantharides;  but  its  restraining  influence  over  the  blood 
is  speedier  and  more  decisive  than  over  the  albumen  of  the  urine.  Some- 
times it  checks  the  greater  part  of  the  blood,  but  a  small  quantity  re- 
mains for  some  weeks.  This  is  especially  the  case  when  the  patient  gets 
up,  for  even  a  small  amount  of  exercise  often  exerts  remarkable  influence 
on  the  renal  bleeding.  Merely  sitting  up  in  bed  in  some  cases  notably 
increases  the  bleeding. 

Cantharides,  in  a  similar  dose,  has  been  recommended  even  in  the 
acute  stage  of  Bright's  disease;  and  when  the  kidney,  having  undergone 
fatty  degeneration,  secretes  very  little  urine. 

After  its  separation  by  the  kidneys  cantharides  acts  as  an  irritant  to 
the  urinary  tract,  and  may  be  employed  in  cystitis,  gonorrhcea,  and  gleet. 
A  drop  of  the  tincture,  although  five  are  sometimes  required,  given  three 
or  four  times  a  day,  is  j)articularly  useful  in  cases  where  there  is  frequent 
desire  to  make  water,  accompanied  by  great  pain  in  the  region  of  the 
jDrostate  gland,  and  along  the  urethra,  while  at  other  times  severe  twinges 
of  pain  are  felt  in  the  same  part,  the  urine  being  healthy,  or  otherwise 
containing  an  excess  of  mucus,  or  even  a  small  amount  of  pus. 


3IUSTARD.  313 

Women,  especially  middle-aged  women,  often  suffer  from  frequent 
desire  to  pass  water,  or  inability  to  hold  it  long,  sometimes  only  in  the 
day  on  moving  about.  Micturition  causes  no  pain,  neither  is  there  any 
straining,  and  the  urine  is  natural.  Other  women  cannot  help  passing  a 
little  urine  on  straining,  or  sneezing,  or  coughing.  Sometimes  women 
are  troubled  with  both  sets  of  symptoms,  which  appear  due  to  weakness 
of  the  sphincter  of  the  bladder.  One  or  two  drojis  of  tincture  of  can- 
tharides,  three  or  four  times  a  day,  will  in  many  cases  afford  great  relief, 
and  sometimes  cure  with  astonishing  rapidity,  even  when  the  symptoms 
have  lasted  months  or  years. 

Tincture  of  cantharides  is  useful  in  the  incontinence  of  urine  of  the 
aged,  even  when  due  to  paralysis,  and  sometimes  in  that  of  children. 
"With  children,  however,  it  is  inferior  to  belladonna.  Unfortunately, 
each  remedy  fails  in  a  not  inconsiderable  number  of  cases. 

A  drojD  of  the  tincture,  three  times  a  day,  in  the  majority  of  cases, 
will  abate  or  remove  chordee. 

Cantharides  affects  the  generative  organs.  Large  quantities  of  the 
drug  congest  and  inflame  these  parts,  and  often  produce  erection  of  the 
jienis,  effects  generally  attributed  to  the  sympathy  existing  between  the 
genitary  and  urinary  tracts.  It  certainly  excites  the  sexual  appetite, 
and  has  been  often  given  criminally  for  this  purpose.  Full  doses  of 
cantharides,  twenty  to  thirty  drops  of  the  tincture,  or  half  a  grain  of 
the  powder  with  full  doses  of  scsquichloride  of  iron  and  phosphoric  acid, 
or  nux  vomica,  three  times  daily,  is  a  combination  effective  in  some 
cases  of  impotence;  in  the  impotence  of  old  age,  and  in  that  resulting 
from  self-abuse,  or  sexual  excess,  it  has  proved  successful,  and  the  patient 
has  begotten  children.  Cantharides  and  iron  combined  are  useful  in 
some  cases  of  seminal  emissions. 

Cantharides  has  been  sometimes  successfully  employed  to  produce 
abortion ;  but  the  danger  is  so  great  as  to  deter  an}'  medical  man  from 
using  this  drug.  Lahousse  finds  that  cantharides  affects  simultaneously 
the  malpighian  bodies,  the  renal  tubules  and  matrix.  The  malpighian 
vessels  are  greatly  congested;  albumen,  leucocytes,  and  a  few  red  cor- 
puscles escape;  the  ei^ithelium  covering  the  vessels  and  lining  the 
capsule  swells  and  desquamates;  the  endothelium  of  the  vessels  swells 
and  may  choke  the  vessels;  the  tubule  cells  swell,  become  granular  and 
die.  The  tubules  contain  haemoglobin  in  form  of  brilliant  red  homo- 
geneous cylinders.  Leucocytes  escape  into  the  matrix.  Other  observers 
hold  that  the  malpighian  bodies  are  alone,  or  chiefly,  affected. 


MUSTARD. 


A  MUSTARD  poultice  is  in  common  household  use  as  a  counter-irritant, 
and  an  excitant.  Much  that  has  been  said  of  blisters  applies  to  mustard 
poultices.  (See  Counter-Irritation.)  As  has  been  eleswhere  stated,  can- 
tharides need  seldom  be  applied  to  produce  much  vesication;  and  with 
regard  to  mustard,  vesication  should  be  carefully  avoided,  as  the  sore  so 
produced  is  intractable,  heals  slowly,  and  pains  greatly.  Although  mus- 
tard may  be  used  in  all  cases  where  we  should  employ  cantharides,  short 
cf  vesication,  still  there  are  differences  in  their  action.    A  mustard  poultice 


314  MUSTARD. 

is  more  painful  than  a  blister,  producing  a  severe  burning,  soon  becom- 
ing unendurable,  and  if  not  speedily  removed  creating  troublesome  vesi- 
cation. A  mustard  poultice  can  rarely  be  borne  longer  than  twenty 
minutes  or  half  an  hour;  if  the  skin  is  delicate,  as  in  children  and  many 
women,  it  cannot  be  endured  for  so  long.  Owing  to  the  pain  produced 
and  to  its  prompter  action,  a  mustard  poultice  is  more  effective  than  a 
blister  when  applied  to  rouse  a  drowsy  and  comatose  patient  from  poison- 
ing by  opium  or  alcohol,  or  in  certain  conditions  occurring  in  the  course 
of  fevers.     (See  Counter-Irritation.) 

Mustard  leaves  may  be  used  in  place  of  a  mustard  poultice.  As  they 
often  produce  rather  severe  pain,  one,  two,  or  three,  layers  of  damped 
muslin  should  be  placed  between  the  leaf  and  the  skin. 

When  a  mustard  poultice  is  employed  to  affect  deep-seated  diseased 
organs,  as  in  bronchitis,  pleurisy,  or  pneiimonia,  its  action  should  be  sus- 
tained for  a  long  time,  over  a  considerable  extent;  the  larger  the  tract  of 
skin  attacked,  the  greater  is  its  influence  on  the  organs  beneath.  Small 
mustard  poultices  are  less  useful,  except  to  remove  a  localized  pain.  The 
poultice,  diluted  with  bread  or  oatmeal,  should  be  of  a  size  sufficient  to 
cover  the  front  or  back  of  the  chest,  or  both,  and  should  be  continued  for 
five,  six,  or  more  hours.  There  is  a  prevalent  idea,  perhaps  a  true  one, 
that  the  action  of  cantharides  is  more  searching,  and  affects  the  deeper 
parts  more  thoroughly. 

In  bronchitis  the  whole  chest  of  a  child  should  be  enveloped  in  a 
jacket-poultice,  which  may  be  retained  in  its  place  by  the  following  con- 
trivance:— The  poultice  is  spread  on  a  piece  of  linen,  sufficiently  large  for 
the  purpose,  to  which  tapes  are  tacked ;  the  tapes  may  be  tied  over  each 
shoulder,  and  at  three  places  in  front  of  the  chest.  The  poultice  must 
be  made  with  tepid  water;  boiling  water  evaporates  the  active  principle, 
vinegar  destroys  it,  and  alcohol  prevents  its  formation.  On  removing  the 
poultice  the  skill  should  be  sponged  with  warm  water,  or,  if  the  smarting 
is  severe,  with  ether,  and  then  the  application  of  a  layer  of  cotton- wool, 
although  for  the  first  few  minutes  it  aggravates  the  pain,  soon  subdues 
it  altogether. 

A  general  mustard-bath,  when  appropriately  used,  often  does  great 
good.  Although  almost  exclusively  used  for  children,  it  is  just  as  service- 
able for  adults.  It  may  be  employed  on  the  recession  of  the  rash  of  any 
of  the  eruptive  fevers,  to  bring  it  back  to  the  skin.  Again,  in  severe 
general  bronchitis  of  children,  this  form  of  bath  is  of  great  service  as  a 
counter-irritant.  A  tablespoonful  of  mustard  should  be  added  to  a  bath 
sufficiently  large  for  the  child,  who  should  be  held  in  it  by  the  nurse  till 
her  arms  tingle  and  smart. 

In  case  of  arrested  catamenia  a  mustard  sitz-bath  may  be  used  to  redden 
and  irritate  the  skin  of  the  buttocks  and  thighs,  a  few  days  before,  and 
during  the  time  the  missing  discharge  is  due.  A  course  of  mustard-baths 
assists  considerably  the  restoration  of  the  uterine  functions. 

Added  to  a  hot  foot-bath,  mustard  is  used  to  relieve  headaches,  con- 
gestion of  the  head,  and  inflammations  of  the  internal  organs.  A  mus- 
tard poultice,  or  the  more  convenient  mustard  leaf,  covered  with  one, 
two,  or  three  folds  of  muslin,  according  to  the  susce^jtibility  of  the  patient 
to  the  action  of  the  poultice,  applied  to  the  nape  of  the  neck,  is  often 
serviceable  in  various  forms  of  headache. 

It  excites  in  the  stomach  a  sensation  of  warmth,  and  slight  pain, 
which  may  be  mistaken  for  hunger,  giving  rise  to  the  notion  that  mustard 


CAPSICUM.  315 

sharpens  the  appetite,  and  promotes  digestion;  but  it  lias  been  proved 
that  mustard  does  not  increase  tlie  secretion  of  gastric  juice. 

It  is  strange  that  a  substance  which  acts  so  powerfully  on  the  skin 
should  affect  so  slightly  the  mucous  membrane  of  the  stomach;  consider- 
able quantities  may  be  swallowed  without  other  effect  than  the  production 
of  nausea  and  sickness.  The  mild  action  of  mustard  on  the  mucous 
membrane  cannot  be  explained  by  its  expulsion  by  vomiting;  for,  even 
when  retained,  it  excites  only  a  little  catarrh  of  the  stomach.  Mustard  is 
used  as  an  emetic  when  no  other  is  at  hand,  and  when  no  time  is  to  be 
lost.  Cases  of  obstinate  and  even  dangerous  hiccup  are  reported  which 
have  been  immediately  cured  by  drinking  an  infusion  made  with  a  tea- 
spoonful  of  mustard  steeped  in  four  ounces  of  boiling  water  for  twenty 
minutes,  and  then  strained. 

Mustard  appears  to  have  very  little  action  on  the  intestines,  beyond 
making  the  motions  moister. 

With  many  persons  even  a  very  small  quantity  of  mustard,  or  pepper, 
or  capsicum,  greatly  increases  their  piles,  and  excites  severe  itching  of 
the  anus.  Piles  are,  indeed,  a  delicate  barometer,  as  it  were,  and  patients 
find  that  they  immediately  tell  them  when  they  have  transgressed,  even 
in  a  slight  degree,  their  restrictive  rules.  Thus  a  little  excess  of  food, 
too  rich  in  fat,  a  glass  of  champagne,  etc.,  will,  inevitably,  increase  their 
piles  next  moring,  which  become  swollen,  painful,  and  protrude. 

Some  of  the  active  principle  passes  into  the  blood,  but  the  action  of 
sinapine  on  the  organs  is  unknown.  It  is  reputed  to  be  diuretic,  but  this 
is  doubtful;  moreover,  its  advocates  fail  to  discriminate  the  cases  in  which 
it  is  supposed  to  be  beneficial. 

It  is  said  to  be  useful  in  whooping-cough. 


CAPSICUM. 


•  Capsicfm  irritates  and  inflames  the  skin,  producing  redness,  a  sensa- 
tion of  Avarmth  or  burning,  and  even  vesication,  but  its  preparations  are 
rarely  employed  as  rubefacients.  The  tincture  is  sometimes  lightly 
painted  over  unbroken  chilblains,  but  it  is  inferior  to  the  ointments  of 
iodine.  The  following  capsicum  preparation  of  Dr.  Rheims  is  highly 
lauded  for  chilblains: — 

"  Make  a  strong  tincture  of  capsicum  pods  by  steeping  them  for 
several  days  in  a  warm  place,  in  twice  their  weight  of  rectified  spirits  of 
wine.  Dissolve  gum  arable  in  water  to  about  the  consistency  of  treacle. 
Add  to  this  an  equal  quantity  of  the  tincture,  stirring  it  together  with  a 
small  brush,  or  a  large  camel's  hair  pencil,  until  they  are  well  incorporated. 
The  mixture  will  be  cloudy  and  opaque.  Take  sheets  of  silk  or  tissue- 
paper,  give  them  with  the  brush  a  coat  of  the  mixture;  let  them  dry,  and 
then  give  another.  Let  that  dry,  and  if  the  surface  is  shining,  there  is 
enough  of  the  peppered  gum;  if  not,  give  a  third  coat.  This  paper, 
applied  in  the  same  way  as  court-plaster  to  chilblains  that  are  not  broken, 
and  burns  that  are  not  blistered,  speedily  relieves  the  itching  and  the  pain. 
It  acts  like  a  charm,  and  effects  a  rapid  cure.  The  same  with  discolored 
bruises.  It  likewise  allays  rheumatic  pains  in  the  joints."  (Vide  Iodine.) 
My  friend,  Mr.  Henry  Buck,  employs  capsicum  in  recent  lumbago. 


316  IPECACUANHA. 

neuralgia,  toothache,  rheumatic  pains,  and  acute  torticollis.  He  in- 
fuses a  large  handful  of  crushed  capsicum  pods  in  a  pint  of  hot  or  cold 
water  for  thirty-six  hours;  he  applies  a  piece  of  lint  soaked  in  this  liquid 
to  the  affected  part,  covering  it  with  thin  gutta-percha.  It  never  vesi- 
cates, and,  indeed,  a  stronger  preparation  may  be  used.  The  effects,  he 
says,  are  often  very  striking;  for  instance,  he  cures  acute  torticollis  in  ten 
minutes.  A  quack  doctor  in  the  West  of  England,  who  told  his  secret 
to  Mr.  Buck,  had  long  and  successfully  employed  this  preparation. 
Powdered  capsicum  thickly  sprinkled  on  a  moist  handkerchief,  or  on  a 
piece  of  moist  brown  paper,  applied  to  the  skin  is  a  jjleasant,  soothing 
counter-irritant,  which  seldom  produces  redness. 

Preparations  of  capsicum  have  a  burning,  tingling  taste,  and  act  on  the 
mucous  membrane  as  on  the  skin.  The  tincture,  as  a  gargle,  in  the  pro- 
portion of  a  drachm  to  half  a  pint  of  water,  is  useful  in  some  sore-throats, 
and  may  be  applied  under  the  same  conditions  which  indicate  the  use  of 
nitrate  of  silver.  Thus,  in  the  very  early  stage  of  tonsillitis  or  pharyngi- 
tis, either  of  these  substances,  which,  acts  as  an  irritant,  will  check  the 
inflannnation ;  but  when  the  deep  parts  become  involved,  and  the  tissues 
much  swollen,  irritants  of  any  kind  do  great  harm.  In  malignant  sore- 
throat,  capsicum  gargle  may  be  used  with  advantage  to  stimulate  the 
tissues  into  a  healther  condition,  and  here,  again,  its  action  is  similar  to 
that  of  nitrate  of  silver.  In  relaxed  throat,  when  the  mucous  membrane 
is  bathed  with  a  gray  mucus,  or  with  pus,  the  same  gargle  may  be  em- 
ployed, although  it  is  probably  not  superior  to  the  glycerine  of  tannic  acid. 

It  acts  as  an  irritant  in  the  stomach,  and,  in  large  quantities,  will 
produce  gastro-enteritis.  It  is  often  used  as  a  condiment  to  spur  diges- 
tion, but  whether  it  is  effective  in  this  respect  is  undetermined.  The 
stomach  becomes  accustomed  to  capsicum,  and  at  last  large  quantities 
must  be  eaten  to  produce  any  effect. 

I  can  indorse  Dr.  Lyon's  strong  recommendation  of  capsicum  in  dip- 
somania. Ten-minim  doses  of  the  tincture  obviate  the  morning  vomiting, 
remove  the  sinking  at  the  pit  of  the  stomach,  the  intense  craving  for 
stimulants,  and  promote  appetite  and  digestion.  It  should  be  taken 
shortly  before  meals,  or  whenever  there  is  depression  and  craving  for  alco- 
hol. Capsicum  also  induces  sleep,  especially  in  the  early  stages  of  delirium 
tremens.  Dr.  Lyon  sometimes  gives  twenty  or  even  thirty  grains  made  into 
a  bolus  with  honey,  and  repeats  the  dose  in  three  hours  if  the  first  fails  to 
induce  sleep.     He  says  this  quantity  does  not  disturb  the  stomach. 

Capsicum  is  often  useful  to  dipsomaniacs,  to  enable  them  to  overcome 
their  pernicious  habit.  By  removing  the  sinking  at  the  pit  of  the  stomach 
it  often  enables  the  drunkard  to  resist  the  drink-crave.  A  draught  com- 
posed of  ten  minims  of  tincture  of  capsicum,  ten  grains  of  bromide  of 
potassium,  a  drachm  of  spirits  of  ammonia,  taken  several  times  daily,  is 
very  serviceable;  or  the  bromide  of  potassium  may  be  omitted,  and  re- 
placed with  two  minims  of  liquor  arsenicalis,  or  by  a  few  drops  of  tincture 
of  nux  vomica  or  tincture  of  orange-peel. 

Capsicum  is  very  useful  in  summer  diarrhoeas,  and  in  diarrhoias  per- 
sisting after  the  expulsion  of  the  exciting  irritant.     It  is  used  in  flatulence. 


IPECACUANHA  AND  ITS  PREPARATIONS. 

When'  applied  to  the  skin,  ipecacuanha  after  some  time  produces  a 
sensation  of  warmth,  attended  with  redness,  and  the  formation  of  papules; 


IPECACUANHA.  317 

sometimes  it  even  produces  pustules,  which  on  healing  are  not  followed 
by  pitting  or  scarring. 

It  has  a  disagreeable  bitter  taste,  and  excites  the  flow  of  saliva. 

In  some  persons  the  minutest  quantity  produces  peculiar  effects  on  the 
membrane  covering  the  eyes  and  lining  the  nose  and  respiratory  tract. 
On  smelling  the  drug,  or  even  entering  a  room  where  it  is  kept,  they  are 
affected  with  swelling  of  the  loose  tissues  around  the  eyes,  with  injection 
of  the  conjunctiva,  rejieated  sneezing,  abundant  discharge  from  the  nose, 
severe  tensive  frontal  pain  of  the  head,  much  oppression  at  the  chest,  with 
frequent  cough,  and  the  signs  and  symptoms  of  bronchitis.  Ipecacuanha 
thus  excites  symptoms  and  appearances  similar  to  those  occurring  in  hay 
fever;  that  is,  it  excites  a  certain  catarrhal  inflammation  in  the  mucons 
membranes.  It  is  highly  probable  that  ipecacnanha  produces  similar  re- 
sults in  all  persons,  and  that  its  action  on  individuals  differs  only  in  de- 
gree. Indeed,  it  is  probable,  as  we  shall  see,  that  ipecacuanha  affects  all 
the  mncous  membranes. 

Small  doses  produce  in  the  stomach  a  slight  sensation  of  nneasiness, 
with  increase  of  mucus,  whilst  larger  doses  excite  nausea  and  a  still  greater 
secretion  of  mncns  from  the  stomach  and  from  the  bronchial  tubes.  In- 
crease of  mncns,  indeed,  occurs  with  all  nauseating  medicines,  bnt  prob- 
ably ipecacnanha  excites  the  secretion  of  nmcus  independently  of  its  action 
as  a  nauseant  and  emetic.  In  animals  large  doses  are  stated  to  produce  in- 
flammation of  the  mucous  membranes  of  the  stomach,  intestines,  and  bron- 
chial tubes. 

Ipecacuanha  is  frequently  used  in  catarrh  of  either  the  stomach  or 
lungs.  It  is  especially  useful  when  the  secretion  from  the  lungs  is  abun- 
dant and  tenacious. 

In  larger  doses  it  produces  both  nausea  and  vomiting,  and,  like  all 
other  emetics,  some  general  weakness,  with  sweating;  and  if  there  is  any 
spasm,  relaxation  of  it.  Thus,  in  nauseating  doses,  the  drug  is  both  dia- 
phoretic and  antispasmodic. 

It  is  a  mild,  tardj^  but  certain  emetic.  It  produces  repeated  vomiting, 
unaccompanied  by  much  nausea  or  prostration;  in  these  respects,  and 
also  in  its  slighter  action  on  the  bowels,  it  differs  from  tartar-emetic.  Its 
tardy  action  renders  it  an  unfit  emetic  in  cases  of  poisoning,  when  the  sul- 
phates of  zinc  or  copper  are  to  be  preferred. 

M.  Cliouppe,  who  has  investigated  the  action  of  emetics,  finds  that 
after  section  of  the  pneumogastric  nerve,  the  injection  of  apomorphia  or 
tartar-emetic  into  a  vein,  excites  vomiting  as  quickly  and  abundantly  as 
when  the  nerve  is  uncut,  whilst  emetin  does  not  excite  vomiting.  As 
regards  emetin.  Dr.  Dyce  Duckworth's  experiments  with  emetin  lead 
him  to  a  similar  conclusion.  M.  Chouppe  concludes  that  apomorphia  and 
tartar-emetic  act  directly  on  the  vomiting  centre,  and  that  emetin  acts 
through  the  termination  of  the  pneumogastric  nerve. 

On  account  of  its  slight  irritant  action  on  the  mucoiis  membrane 
of  the  stomach,  and  perhaps  by  virtue  of  the  strong  movements  it  pro- 
duces in  that  organ  when  it  excites  vomiting,  ipecacuanha  is  found  useful 
in  irritative  dyspepsia,  both  of  the  acute  and  chronic  kind,  With  some 
practical  authorities  it  is  a  favorite  plan  to  give  occasionally  in  such  case 
ipecacuanha  in  emetic  dose.  It  is  sometimes  given  to  produce  vomiting 
in  the  bronchitis  of  children,  where  the  patient  breathes  with  difficulty 
from  the  presence  of  mucus  in  the  bronchial  tubes.  The  movements  of 
vomiting  expel  nmch  mucus  mechanically,  and  temporarily  improve  the 


318  IPECACUANHA. 

breathing.  From  its  mildness  ipecacuanhu  is  fitted  for  sucli  cases,  and 
as  an  emetic  for  delicate  persons. 

The  quantity  required  to  excite  vomiting  varies  greatly,  the  smallest 
quantity  being  sufficient  for  some,  whilst  others  find  large  doses  inopera- 
tive. As  a  rule,  children  require  large  doses,  and  babies  only  a  few 
months  old  may  need  ten  or  twenty  grains  of  the  powder. 

Few  remedies  are  so  efficacious  as  ipecacuanha  in  checking '  certain 
kinds  of  vomiting.  In  numerous  instances  I  have  witnessed  the  efficacy 
of  drop  doses  of  the  wine  administered  every  hour,  or  three  times  a  day, 
according  to  the  urgency  of  the  case,  in  checking  the  following  kinds  of 
sickness: — 

].  It  will  check  the  vomiting  of  pregnane}^  This  vomiting  is  not 
always  of  the  same  kind.  In  some  cases  it  occurs  only  in  the  morning, 
and  is  excited  by  the  first  waking  movements.  This  form  Avill  in  most 
instances  yield  to  ipecacuanha,  taken  in  the  way  described;  but  should  it 
fail,  the  administration  of  the  medicine  to  the  patient  on  waking,  and 
sometimes  before  any  movement  is  allowed,  will  generally  give  relief.  In 
other  instances,  the  vomiting  occurs  not  only  in  the  morning,  but  fre- 
quently during  the  day,  recurring  whenever  food  is  taken,  and  may  be  so 
severe  that  the  stomach  rejects  all  nourishment,  while  during  the  intervals 
of  meals  there  may  be  constant  nausea  and  great  loathing  of  all  kinds  of 
food.  Vomiting  and  nausea  of  this  kind  will,  in  most  instances,  be  im- 
mediately arrested  by  ipecacuanha,  when  the  appetite  will  return,  and  the 
stomach  will  bear  almost  any  kind  of  food.  Ipecacuanha  may  check  the 
nausea  and  vomiting,  with  the  exception  of  the  early  morning  attack,  but 
on  taking  a  dose  immediately  on  waking  this  early  sickness  too  will  gen- 
erally cease,  thougli  in  some  cases  it  defies  treatment. 

In  other  instances  the  early  morning  vomiting  may  be  absent,  and  the 
attack  may  occur  only  on  taking  food,  increasing  in  severity  as  the  day 
advances,  and  becoming  most  severe  in  the  evening.  Should  ipecacuanha, 
as  is  sometimes  the  case,  fail  to  check  this  form  of  sickness,  nux  vomica 
will  generally  give  relief. 

In  some  pregnaiicies,  besides  the  sickness  and  nausea,  there  is  much 
heartburn,  and  perhaps  great  flatulence,  symptoms  which  in  many  cases 
j'ield  quickly  to  ipecacuanha;  but  here  agahi,  should  this  remedy  fail, 
nux  vomica  Avill  generally  afford  relief,  though  the  symptoms  yield  more 
surely  to  both  remedies.  It  is  singular  that  while  ipecacuanha  will  remove, 
in  pregnant  patients,  excessive  flatulence,  co-existing  Avitli  sickness,  yet  if 
the  flatulence  occurs  without  sickness  this  medicine  is  generally  unavail- 
ing, and  recourse  must  be  had  to  nux  vomica,  charcoal,  sulphurous  acid, 
or  sulpho-carbolate  of  soda;  and  of  all  these  drugs  most  reliance  is  to  be 
placed  on  the  suli)ho-carbolate,  in  doses  of  five  to  fifteen  grains  dissolved 
in  water,  and  administered  immediately  after  a  meal. 

It  has  been  stated  that,  in  some  instances,  nux  vomica  succeeds  when 
ipecacuanha  fails;  and  this  is  nottibly  the  case  when  the  tongue  is  coated 
with  a  creamy  fur,  Avhen  the  stomach  is  out  of  order,  and  when  there  is 
much  acidity  and  heartljurn.  In  such  cases  botli  nux  vomica  and  ipeca- 
cuanha may  be  given  simultaneously. 

It  nnist  be  confessed,  however,  that  in  certain  instances,  at  present 
unexplained,  ipecacuanha  fails  to  afford  the  expected  relief.  In  such 
cases  vomiting  is  possibly  kept  up  by  a  displacement  of  the  uterus,  or  by 
a  chronic  inflammation  of  this  organ,  or  of  its  cervix,  or  os.  as  was  long 
since  pointed  out  by  Dr.  Henry  liennctt,  wh'ni  of  course  the  treatment 
should  be   directed  to  the  removal  of  these  conditions. 


IPECACUANHA.  319 

2.  Some  women,  who  during  pregnancy  are  nntroubled  with  nansea 
and  vomiting,  yet  suffer  with  both  tliese  symptoms  during  the  whole  or 
part  of  the  time  of  suckling.  These  symptoms  usually  begin  after  the 
first  few  weeks  of  suckling,  and  continue  till  the  child  is  weaned,  and 
may  be  so  severe,  and  produce  so  much  exhaustion,  as  to  compel  the 
mother  to  wean  her  child  prematurely.  Great  flatulence  may  accompany 
the  nausea  and  vomiting.  Drop  doses  of  ipecacuanha  wine,  administered 
three  times  a  day,  will  commonly  soon  cure  these  symptoms. 

3.  Similar  troubles  to  those  just  pointed  out  afflict  some  women  at 
each  menstrual  epoch,  occurring  immediately  before,  during,  or  directly 
after  the  period.     These  cases,  too,  will  generally  yield  to  ipecacuanha. 

4.  The  morning  vomiting  of  drunkards;  but  this  morbid  state  is  more 
effectively  controlled  by  arsenic. 

5.  The  morning  vomiting  which  sometimes  accompanies  general  Aveak- 
ness,  and  is  met  with  in  convalescents  from  acute  diseases. 

G.  Ipecacuanha  will  at  once  control  the  vomiting  in  children,  with 
acute  catarrh  of  the  stomach.  Indeed,  this  remedy  appears  to  exercise 
greater  influence  over  the  vomiting  of  children  than  over  that  of  adults. 
Arsenic  succeeds  admirably,  likewise,  in  removing  the  vomiting  of  acute 
stomach  catarrh;  and  either  remedy  may  advantageously  be  given  with 
aconite,  to  subdue  the  inflammation,  and  reduce  the  fever. 

7.  In  whooping-cough  ipecacuanha  often  removes  or  lessens  the  vomit- 
ing, when  this  is  occasioned  by  the  violence  of  the  cough,  although  its 
severity  may  in  no  degree  be  lessened.  Cases  of  vomiting  from  this  cause 
occur,  which  are  unaffected  by  ipecacuanha,  but  which  yield  immediately 
to  alum.     (See  Alum.) 

8.  A  species  of  vomiting  occurs  after  meals,  without  nausea  or  pain, 
or  even  discomfort,  the  food  being  merely  rejected  partially,  or  often  very 
little  digested.  This  condition  may  persist  a  considerable  time,  but  ipe- 
cacuanha wine,  in  many  instances,  quickly  cures  it.  x\rsenic,  however,  is 
a  still  better  remedy. 

Ipecacuanha,  in  my  experience,  proves  of  little  use  in  the  following 
forms  of  vomiting: — 

(a.)  In  children,  where  the  vomited  matters  are  composed  of  large  hard 
lumps  of  curdled  milk.  In  sucli  a  case,  Avhen  diarrhoea  is  present,  lime- 
water  mixed  with  the  milk  is  the  best  remedy,  but  if  the  child  is  consti- 
pated, bicarbonate  of  soda  should  be  substituted  for  the  lime-water;  and, 
should  these  remedies  both  fail,  milk  must  be  altogether  excluded  from  the 
diet. 

(b.)  Ipecacuanha  is  not  generally  useful  in  that  form  of  vomiting 
met  with  in  young  children  a  few  weeks  or  months  old,  who  almost  im- 
mediately after  the  ingestion  of  milk,  reject  it  with  considerable  force, 
either  curdled  or  not,  perhaps  through  both  nose  and  mouth.  At  the 
post-mortem  examination  nothing  may  be  discovered  to  explain  this  fatal 
form  of  vomiting;  but  sometimes  the  mucous  membrane  of  the  stomach 
is  extremely  soft,  and  looks  as  if  made  of  Avater  arrowroot.  This  form  of 
vomiting  is  best  treated  by  hourly  small  doses  (one-third  of  a  grain)  of 
gray  powder,  or  by  calomel  (one-tenth  of  a  grain). 

(c. )  In  hysterical  vomiting. 

Ipecacuanha  is  sometimes  effective  in  checking  the  vomiting  from 
cancer  of  the  stomach,  and  has  succeeded  sometimes  after  the  more  com- 
monly used  remedies  have  entirely  failed. 

1  have  several  times  met  with  cases  where  the  symptoms  may  be  com- 


320  IPECACUAlSrHA. 

])ared  to  rumination.  The  food,  quite  tasteless,  has  simply  regurgitated 
into  the  mouth,  without  any  effort  at  vomiting.  These  patients  often 
chew  the  food  a  second  time  and  swallow  it  without  distaste.  There  may 
be  no  other  symptoms,  though,  so  far  as  I  have  seen,  this  regurgitation 
occurs  generally  when  the  health  is  disordered.  I  have  seen  ipecacuanha 
or  arsenic  promptly  remove  this  regurgitation,  though  it  may  have  con- 
tinued, with  intermissions,  for  months  or  years.  Emetine  excites  in  dogs 
diarrhoea,  and  even  dysenteric  stools. 

Ipecacuanha  excites  an  increased  production  of  mucus  m  the  mucous 
coat  of  the  intestines,  and  becomes  in  this  way  slightly  purgative,  and  is 
reputed  to  assist  the  action  of  other  purgative  medicines,  as  jalap.  It  is 
also  stated  that  a  grain  of  powdered  ipecacuanha  each  morning,  while  fast- 
ing, will  relieve  constipation  depending  on  great  torpor  of  the  intestines. 
The  same  treatment,  it  is  said,  will  remove  the  dyspepsia  frequently  asso- 
ciated with  constipation,  and  characterized  by  depression  of  s])irits,  some 
flatulence,  coldness  of  the  extremities,  and  by  the  food  lying  on  the  stom- 
ach "like  a  heavy  Aveight." 

Rutherford,  in  his  experiments  on  fasting  dogs,  finds  ipecacuanha. 
Avhen  mixed  with  bile  and  introduced  into  the  duodenum,  a  powerful 
hepatic  stimulant.  He  employed  sixty  grains,  Avhich  did  not  jiurge,  but 
increased  the  mucus  of  the  intestinal  canal. 

It  is  well  known  that  this  drug  is  largely  and  beneficially  employed 
in  dysentery.  In  some  epidemics  it  answers  admirably,  while  in  others  it 
appears  to  fail.  Large  doses  are  required,  and  will  often  succeed  where 
small  ones  fail.  Sixty  to  ninety  grains  of  the  powder  are  given  at  a  dose, 
and  repeated  if  required,  oftentimes  without  the  production  of  either  nau- 
sea or  sickness;  but  these  symptoms,  should  they  arise,  may  generally  be 
obviated,  if  the  patient,  after  taking  the  drug,  will  remain  quietly  on  his 
back.  In  chronic  cases  not  requiring  prompt  treatment,  it  is  a  good  prac- 
tice to  administer  the  first  dose  at  night  when  the  patient  has  gone  to  bed. 
Should  the  first  few  doses  excite  sickness,  it  soon  passes  away  on  persever- 
ing with  the  medicine. 

E.  8.  Docker,  who  has  had  a  very  large  experience  of  this  treatment, 
extols  ipecacuanha.  He  states  that  its  effects  in  suitable  cases  are  almost 
instantaneous,  the  motions  in  the  very  worst  cases  becoming  natural  in 
frequency  and  character.  Ninety  grains  of  the  powder  cuts  short  at  once 
very  severe  attacks  of  dysentery,  not  only  restraining  the  discharge  off- 
hand, but  freeing  the  patient  from  pain  immediately,  while  inducing  nat- 
ural stools  without  straining  or  griping.  The  disposition  to  relapse,  so 
common  in  acute  dysentery,  is  not  observed  after  the  ipecacuanh'\  treat- 
ment; and  there  is  no  need  for  after-treatment:  nor  for  any  great  precau- 
tions concerning  the  quality  of  the  food.  After  a  large  dose,  as  sixty  or 
ninety  grains,  Docker  recommends  an  interval  of  ten  or  twelve  hours'  l)e- 
fore  repeating  it,  and  should  the  bowels  meanwhile  remain  quiet,  to  forego 
the  medicine  altogether.  It  is  recommended  to  inject  ipecacuanha,  espe- 
ially  when  it  is  rejected  by  the  stomach. 

An  injection  three  or  four  times  a  day,  of  half  a  drachm  or  a  drachm 
of  powdered  ipecacuanha  suspended  in  a  small  quantity  of  fluid  into  the 
rectum,  is  very  useful  in  acute  and  chronic  dysentery. 

The  dysenteric  diarrhoea  of  children,  whether  acute  or  chronic,  will 
generally  yield  speedily  to  hourly  drop  doses  of  ipecacuanha  wine.  The 
especial  indication  for  this  treatment  are  slimy  stools,  green  or  not,  witli 
or  without  blood.     Vomiting,  if  present,  as  is  commonly  the  case,  affords 


IPECACUANHA .  321 

an  additional  reason  for  the  adoption  of  this  treatment.  After  the  first 
or  second  dose  of  tlie  medicine,  and  generally  before  the  diarrhoea  is 
checked,  the  sickness  will  often  cease.  Sometimes  it  happens  that  although 
the  ipecacuanha  abates  the  number  and  the  dysenteric  character  of  the 
evacuations,  yet  supplementary  treatment  may  be  required. 

The  active  principle  of  ipecacuanha,  without  doubt,  enters  the  blood, 
and  Ave  have  next  to  consider  its  action  on  the  distant  organs  of  the  body. 

It  produces  an  increased  secretion  from  the  bronchial  mucous  mem- 
brane. Some  maintain  that  this  occurs  only  Avhen  ipecacuanha  excites 
nausea,  and  that  the  action  of  the  drug  is  solely  due  to  the  production 
of  this  physiological  state;  for  it  is  well  known  that  during  nausea  an  in- 
creased secretion  takes  place  from  most  of  the  surfaces  of  the  body,  includ- 
ing the  respiratory  mucous  tract.  Others  consider  that  it  can  affect  this 
mucous  membrane  irrespective  of  the  production  of  any  sensation  of  sick- 
ness, and  that  this  is  the  correct  view  is  borne  out  by  the  powerful  effect 
of  even  a  minute  quantity  of  this  medicine  on  the  bronchial  tract  of  some 
persons,  though  the  same  dose  may  fail  to  produce  sickness,  or  even  nau- 
sea. 

Eossbach,  in  his  experiments  on  animals  with  the  trachea  exposed, 
finds  that  emetin,  apomorphia,  and  pilocarpine  administered  through  the 
blood  increase  the  tracheal  secretion,  whilst  atropin  and  its  allies  act  in 
the  reverse  way. 

Ipecacuanha  in  the  form  of  wine  is  of  almost  constant  use  in  bron- 
chitis, when  the  expectoration  is  profuse,  and  diflficult  to  expel. 

The  successful  use  of  a  secret  remedy  by  a  well-known  practitioner  in- 
duced me,  in  conjunction  with  Dr.  William  Murrell,  to  try  the  effect  of 
inhalations  of  ipecacuanha  spray  in  those  obstinate  complaints,  winter 
cough  and  bronchial  asthma.  Our  observations  were  made  during  Janu- 
ary and  February,  and  whilst  undergoing  this  treatment  the  patients  took 
only  colored  water,  and  continued  their  usual  mode  of  living  in  all  re- 
spects. First,  regarding  winter  cough,  we  made  observations  on  twenty- 
five  patients,  whose  ages  varied  between  45  and  72,  with  one  exception, 
that  of  a  woman  of  32  years,  and  we  purposely  selected  severe  cases.  The 
following  general  description  of  a  typical  case  will  serve  in  most  points 
to  illustrate  the  condition  of  them  all: — The  patient  had  been  troubled 
with  winter  cough,  perhaps  for  many  years.  During  the  summer  he  is 
pretty  well,  but  during  the  cold  months,  from  October  to  May,  he  suffers 
sometimes  without  any  intermission,  occasionally  getting  a  little  better, 
and  then  catching  cold;  or  perhaps  he  may  lose  his  cough  for  a  few  weeks, 
but  again  takes  cold  on  the  slightest  exposure.  So  short  is  the  breathing 
that  he  can  walk  only  a  few  yards,  especially  in  the  cold  air,  and  finds  it 
very  hard  work  to  get  upstairs,  and  is  often  quite  unfitted  for  active  life. 
The  breathing  grows  worse  at  night,  so  that  he  cannot  sleep  unless  with 
the  head  propped  up  with  several  pillows.  He  is  troubled,  too,  with  a 
paroxysmal  dyspnoea,  usually  at  night,  which  may  last  several  hours  and 
constrains  him  to  sit  up.  Sometimes  the  breathing  is  difficult  only  on 
exertion,  and  in  most  cases  fogs,  east  winds,  or  damp,  make  it  much  worse. 
The  expectoration,  generally  difficult  to  expel,  varies  greatly.  In  a  few 
cases  there  is  very  little;  usually,  however,  it  is  rather  abundant,  often 
with  little  or  no  rhonchus.  The  cough  is  very  violent,  frequent,  hacking, 
and  paroxysmal,  and  the  fits  may  last  ten  to  twenty  minutes,  and  even  ex- 
cite vomiting.  They  are  generally  brought  on  by  exertion;  nay,  in  bad 
cases,  so  easily  are  they  provoked,  that  the  patient  is  afraid  to  move,  or 
'21 


322  IPECACUANHA. 

even  to  speak.  The  con2;li  and  expectoration  are  much  worse  in  the 
morning  on  waking.  Sometimes  tlie  cougli  is  slight,  and  the  expectora- 
tion is  generally  scanty,  the  distressed  breathing  l^eing  the  chief  symptom. 
The  patient  generally  wheezes  londly,  especially  at  night.  In  a  Ijad  case 
the  legs  swell,  the  patient  is  emphysematous;  there  is  often  no  rhonchus, 
or  only  sonorous  and  sibilant,  or  a  little  bubbling  rhonchus  at  both  bases. 

In  this  common  but  obstinate  complaint  our  results  liave  been  very 
striking,  although  so  bad  was  the  breathing  in  many  of  our  patients  that, 
on  being  shown  into  the  out-patients'  room,  they  dro]>ped  into  a  chair, 
and  for  a  minute  or  so  were  unable  to  speak,  except  in  monosyllables, 
having  no  breath  for  a  sentence.  We  used  the  ordinary  spray  producer 
with  ipecacuanha  wine,  pure  or  variously  diluted.  At  first  it  sometimes 
excites  a  paroxysm  of  coughing,  which  generally  soon  subsides,  but  should 
it  continue  a  weaker  solution  should  be  used.  The  patient  soon  becomes 
accustomed  to  it,  and  inhales  the  spray  freely  into  the  lungs.  At  first  a 
patient  often  inhales  less  adroitly  than  he  learns  to  do  afterwards,  as  he  is 
apt  to  arch  his  tongue  so  that  it  touches  the  soft  palate,  and  consequently 
less  spray  enters  the  chest  than  when  the  tongue  is  depressed.  The  spray 
may  produce  dryness  or  roughness  of  the  throat,  with  a  raw,  sore  sensation 
beneath  the  sternum;  and  sometimes  it  causes  hoarseness,  whilst,  on  the 
contrary,  some  hoarse  patients  recover  their  voice  witli  the  first  inhalation. 
As  they  go  on  with  the  inhalation  they  feel  it  getting  lower  and  lower  into 
the  chest,  till  many  say  they  can  feel  it  as  low  as  the  ensiform  cartilage. 

The  dyspncea  is  the  first  symptom  relieved.  The  first  night  after  the 
spraying  the  paroxysmal  dyspncea  often  improved,  and  the  patient  had  a 
fair  night's  rest,  although  for  months  before  shortness  of  breath  and 
coughing  had  much  broken  the  sleep.  The  difficulty  of  T)reathing  on  ex- 
ertion also  quickly  abates,  for  often  after  oven  the  first  administration  the 
patient  walked  home  from  the  hospital  much  easier  than  he  came  to  it; 
and  this  improvement  is  continuous,  so  that  in  one  or  two  days,  or  a  week, 
the  patient  can  walk  with  very  little  distress,  a  marked  improvement 
takes  place  immediately  after  each  inhalation,  and  although  after  some 
hours  the  breathing  may  again  grow  a  little  worse,  some  permanent  im- 
provement is  gained,  unless  the  patient  catches  a  fresh  cold.  I  have  heard 
patients  say  that  in  a  week's  time  they  could  walk  two  miles  with  less 
respiratory  distress  than  they  could  walk  a  hundred  yards  before  the  use 
of  the  spray.  In  some  instances  two  or  three  days'  daily  spraying  elapses 
before  any  noticeable  improvement  takes  ])lace,  this  comparatively  slow 
effect  being  sometimes  due  to  awkward  inhalation,  so  that  buj^  little  ipe- 
cacuanha ])asses  into  their  bronchial  tubes.  The  effect  on  the  cougli  and 
expectoration  is  also  very  marked,  these  both  greatly  decreasing  in  a  few 
days,  though  the  im2')rovement  in  these  respects  is  rather  slower  than  in 
the  case  of  the  breathing;  sometimes  for  the  first  few  days  the  expecto- 
ration is  even  rather  increased;  it  speedily  alters  in  character,  so  that  it 
is  expelled  much  more  readily,  and  thus  the  cough  becomes  easier,  even 
before  the  expectoration  diminishes.  The  patient  is  soon  enabled  to  lie 
down  at  night  with  his  head  lower,  and  in  a  week  or  ten  days,  and  some- 
times earlier,  can  do  with  only  one  pillow,  an  improvement  which  occurs 
in  spite  of  fogs,  damp,  or  east  winds,  nay,  even  whilst  the  weather  gets 
daily  worse,  and  when  the  patient  is  exposed  to  it  the  chief  part  of  the 
day.  These  patients  all  came  daily  to  the  hospital.  Of  course  it  would 
be  much  better  to  keep  a  patient  iu  a  warm  room. 

Of  the  twenty- five  cases  all  were  benefited  except  one.     In  one  case 


f 


IPECACUANHA.  323 

the  improvement  was  very  gradual,  but  each  inhalation  produced  evident 
temporary  improvement.  In  twenty-one  cases  the  average  number  of 
inhalations  required  was  9.4,  and  the  average  number  of  days  was  twelve 
before  the  patients  were  discharged  cured.  The  greatest  number  of  inhal- 
ations in  one  case  was  eighteen  and  the  smallest  three.  The  case  longest 
under  treatment  required  twenty-four  days,  the  shortest  four. 

In  order  to  ensure,  as  far  as  possible,  only  the  topical  effects  of  the 
ipecacuanha  spray,  we  were  careful  to  direct  the  patient  to  spit  out,  and 
even  to  rinse  out  the  mouth  at  each  pause  in  the  administration,  for  far 
more  wine  collects  in  the  mouth  than  passes  into  the  lungs.  If  this  pre- 
caution is  not  adopted,  sometimes  enough  is  swalloAved  to  excite  nausea, 
and  even  vomiting,  by  which  means  the  bronchial  mucus  is  mechanically 
expelled,  and  of  course  in  this  way  effects  temporary  improvement.  Even 
when  this  precaution  is  observed  a  protracted  inhalation  will  excite  nausea, 
and  sometimes  vomiting,  by  the  absorption  of  the  wine  by  the  bronchial 
mucous  membrane;  though,  strange  to  say,  vomiting,  when  thus  induced, 
was  long  delayed,  even  for  several  hours,  nay,  sometimes  till  the  evening, 
though  the  inhalation  was  used  in  the  morning.  In  our  cases,  however, 
the  improvement  was  not  due  to  the  nauseating  effect  of  the  spray,  for  we 
took  care  to  avoid  this  contingency  by  administering  a  quantity  inadequate 
to  produce  this  result.  The  duration  of  each  inhalation  will  depend  on  the 
amount  of  spray  produced  by  each  compression  of  the  elastic  ball,  or  on 
the  susceptibility  of  the  patient  to  the  action  of  ipecacuanha.  As  a  rule, 
the  patient  at  first  will  bear  about  twenty  squeezes  of  the  S'pray  without 
nausea,  and  will  soon  bear  much  more.  After  two  or  three  squeezes, 
especially  on  commencing  the  treatment,  we  must  pause  a^sdiile.  It  is 
necessary  to  look  at  the  patient's  tongue,  and  tell  him  to  learn  to  depress 
it;  for  if  the  tongue  is  much  arched  it  will  hinder  the  passage  of  the  spray 
to  the  lungs.  It  is  a  good  plan  to  tell  the  patient  to  close  his  nose  with 
his  fingers,  and  to  breathe  deeply.  The  inhalation  should  be  used  at  first 
daily,  and  in  bad  cases  twice  or  thrice  in  the  day,  afterwards  every  other 
day  suffices,  and  the  interval  may  be  gradually  extended.  If  the  ipecacu- 
anha wine  is  diluted,  then  the  spray  must  be  used  a  longer  time.  In 
cold  weather  the  wine  should  be  warmed. 

We  have  tried  the  spray  with  very  satisfactory  results  in  a  few  cases  of 
more  severe,  though  closely  allied,  disease,  which  may  be  thus  summarized: 
— A  patient  has  suffered  for  several  3^ears  from  severe  "  winter  cough," 
with  much  dyspnoea,  cough,  and  expectoration,  and  on  several  occasions 
lias  spat  up  a  considerable  quantity  of  blood.  The  physical  signs  denote 
slight  fibroid  consolidation,  with  excavation  of  both  apices  with  much 
emphysema,  perhaps  atrophous  in  kind.  There  is  little  or  no  rhonchus, 
and  no  fever.  The  expectoration  may  be  slight,  or  very  abundant,  muco- 
purulent, or  purulent.  The  dyspnoea  is  perhaps  so  very  severe  and  is  so 
paroxysmal  as  to  justify  calling  the  case  bronchial  asthma'  with  emphysema 
and  fibroid  phthisis. 

In  this  class  of  cases  the  ipecacuanha  spray  is  almost  as  beneficial  as  in 
that  just  previously  described.  The  spray  soon  controls  the  dyspnoea, 
thus  enabling  the  patient  to  sleep,  greatly  lessens  expectoration  and  cough, 
and  by  these  means  really  improves  the  general  health.  As  in  the  previous 
cases,  the  first  inhalation  may  considerably  improve  the  breathing,  though 
the  effects  are  not  permanent,  the  dyspnoea  returning  in  the  evening,  so 
that  spraying  is  needed  night  and  morning,  and  may  be  required  for  Aveeks 
or  months,  the  ipecacuanha  appearing  rather  to  mitigate  than  to  perma- 
nently cure  the  dyspnea. 


324  IPECACUANHA. 

We  have  used  this  spray  in  cases  of  true  and  severe  bronchial  asthma, 
with  very  opposite  results.  In  one  severe  case,  accompanied  by  a  great 
deal  of  bronchitis,  it  gave  very  great  relief.  The  other  patient,  not  so  ill, 
had  been  all  his  life  asthmatic,  and  on  catcliing  even  a  slight  cold  his 
breathing  became  greatly  oppressed.  In  this  instance  each  application 
of  the  spray  considerably  aggravated  the  dyspnoea,  even  when  the  wine 
was  diluted  with  an  equal  quantity  of  water.  Possibly  a  still  weaker  solu- 
tion might  have  been  borne,  but  we  are  inclined  to  think  that  in  this  case 
any  quantity  of  ipecacuanha  would  have  disagreed,  as  the  tightness  of 
breathing  increased  almost  immediately  on  commencing  the  inhalation. 
The  successful  case  was  a  very  severe  one.  For  years  this  woman  had 
suffered  from  bronchitic  asthma,  and  when  she  applied  to  the  hospital 
was  unable  to  lie  down,  owing  to  violent  paroxysmal  dyspnoea.  The 
worst  attack  began  about  3  a.m.,  compelling  her  to  start  out  of  bed  and 
struggle  for  breath.  She  was  very  emphysematous,  the  expiration  enor- 
mously prolonged.  She  was  very  hoarse.  The  first  inhalation  removed 
the  hoarseness  in  a  few  minutes,  and  much  improved  her  breathing, 
which  continued  freer  until  midnight,  when  the  dyspnoea  returned.  The 
cough  became  easier,  and  she  expectorated  more  freely.  Each  inhalation 
always  gave  her  very  great  and  marked  relief.  She  walked  to  the  hospital 
with  great  difficulty,  being  constrained  to  stop  frequently.  On  entering 
the  room  she  could  not  speak,  but  labored  violently,  and  with  loud 
wheezing,  to  get  her  breath.  A  few  inhalations  would  gradually  set  the 
breathing  free,  so  that  air  entered  more  and  more  freely,  with  gradual  dimi- 
nution of  the  wheezing,  till,  by  the  completion  of  the  inhalation,  she  could 
breathe  without  difficulty.  As  the  breathing  improved  she  could  feel  the 
spray  descending  lower  and  lower  in  her  chest.  At  first  it  would  seem  to 
reach  only  the  back  of  the  tongue,  then  the  top  of  the  sternum,  then 
descend  to  mid-sternum,  and  at  last  she  felt  as  if  it  reached  as  low  as  the 
pit  of  the  stomach.  This  improvement  was  maintained  through  the  day, 
but  at  evening,  a  relapse  would  occur;  yet  her  nights,  though  at  first  bad, 
were  still  decidedly  better  than  before  the  treatment.  Soon,  however, 
the  effects  became  more  lasting,  and  she  slept  well.  On  discontinuing 
the  spray,  however,  the  breathing  again  grew  worse,  and  she  was  obliged 
to  revert  to  the  treatment;  but  unfortunately  she  so  easily  caught  cold, 
and  so  bad  was  the  weather,  that  she  was  obliged  to  stay  away  for  days 
together.  Whilst  her  breathing  improved,  the  cough  and  expectoration 
mended,  but  these  two  symptoms  continued  rather  troublesome.  So 
marked  was  the  benefit  from  the  spray  that  the  patient  and  her  friends 
expressed  their  astonishment,  especially  at  the  prompt  relief  it  gave. 

We  have  tried  it  in  several  additional  cases  of  genuine  asthma,  but  with 
unsatisfactory  results;  for  in  most  cases  it  has  considerably  tightened  the 
breathing  to  such  an  extent  that  patients  have  refused  to  give  it  a  second 
or  third  trial. 

AVe  have  continued  to  carry  on  our  observations  with  ipecacuanha 
wine  spray,  and  with  results  confirmatory  of  the  statements  made  in  the 
Brit.  Meil.  Journal.  We  find,  however,  that  some  patients  are  very  in- 
tolerant of  ipecacuanha  spray;  it  causes  a  good  deal  of  irritation,  and  even 
tightness  of  breathing.  It  is  advisable,  therefore,  at  first  to  dilute  the 
wine  with  one  or  two  parts  of  water,  a  precaution  especially  needful  for 
patients  affected  M'itli  much  dyspncea,  with  lividity;  for  the  spray  may  for 
some  hours  much  intensify  the  difficulty  of  breathing  and  lividity,  so  as 
to  alarm  the  patient  and.  friends. 


IPECACUANHA.  325 

It  ma}^  not  be  much  out  of  place  to  mention  here  that,  in  several 
instances,  we  have  found  the  spray  very  serviceable  in  non-febrile  inflam- 
matory sore  throats,  the  mucous  membrane  being  swollen  and  very  red. 
We  have  found  it  useful,  too,  in  hoarseness  from  congestion  of  the  vocal 
cords.  Where  the  hoarseness  has  lasted  a  few  days  only,  or  one  or  two 
weeks,  the  spray  often  speedily  cures;  but  where  the  hoarseness  has  per- 
sisted three  montbs,  or  longer,  the  spray  improves  the  voice  considerably, 
but  leaves  some  hoarseness. 

The  late  Dr.  Hyde  Salter  strongly  recommended  ipecacuanha  in  hay- 
asthma,  and  in  other  forms  of  asthma,  employing  it  to  cut  short  a  parox- 
ysm of  dyspnoea.  He  thought  that,  in  common  Avith  tobacco  and  anti- 
mony, it  contiwls  by  virtue  of  its  action  as  a  depressant.  He  preferred  it 
to  the  other  two  remedies  just  named,  and  gave  it  in  doses  large  enough 
to  cause  depression,  but  too  small  to  excite  vomiting.  Like  other  de- 
pressants, it  must  be  given  at  the  very  beginning  of  the  attack  of  dvspnoea, 
for  the  influence  of  the  remedy  is  considerably  less  over  a  fully-developed 
attack.  He  preferred  the  powder  to  the  wine,  and  seldom  gave  less 
than  twenty  grains.  This  treatment,  directed  only  against  each  attack  of 
dyspnani,  leaves  the  complaint  in  other  respects  untouched,  and  more 
permanent  relief  must  be  sought  in  an  appropriate  diet  and  a  suitable 
climate. 

Dr.  Hyde  Salter  enforced  particular  attention  to  the  influence  of  diet  on  pure 
asthma.  As  persons  j^rone  to  asthma  suffer  from  tightness  of  the  breath  for  some 
hours  after  a  meal,  and  the  smallest  quantity  of  food  greatly  aggravates  an  attack  of 
asthma,  therefore  the  meals  must  be  small,  and  digestible.  Asthmatic  attacks  occur 
commonly  at  night,  seeming  to  be  favored  by  sleep:  keeping  awake  often  wards  off 
an  attack.  The  attacks  are  especially  liable  "to  occur  after  a  late  meal,  therefore  an 
asthmatic  should  take  a  light  tea,  and  go  without  supper;  in  fact,  should  take  no  full 
meal  after  two  o'clock.  Breakfast  should  be  the  chief  meal.  Asthmatics  must  rise 
early,  to  avoid  a  too  prolonged  fast.  Their  food  must  be  plain,  well-cooked,  and  nu- 
tritious. Milk  and  eggs  form  a  good  diet.  Cocoa  is  better  than  tea,  but  milk  is  better 
than  either.  Mutton  is  preferable  to  beef  or  lamb,  while  pork  and  veal  must  be  pro- 
hibited; new  boiled  potatoes,  or  succulent  vegetables  may  be  permitted.  Fish  is  suit- 
able. Cheese,  dessert,  preserved  meats  or  fruits,  inust  not  be  eaten,  and  stimulants 
of  any  kind  are  generally  bad.  Heavy  malt  liquors,  especially  those  containing  much 
carbonic  acid,  are  the  worst  beverages.  The  quantity  of  food  should  not  be  large, 
although  food  does  not  produce  the  paroxysm  by  its  bulk,  as  the  attack  generally 
occurs  some  hours  after  a  meal,  when  tlie  stomach  is  becoming  empty.  Most  asthmat- 
ics may  eat  what  thej'  like  at  breakfast.  Dr.  Pridham,  who  has  had  great  success  in 
the  treatment  of  asthma,  and  who  long  ago  pointed  out  the  impoi'tance  of  a  regulated 
diet,  orders  the  following  regimen: — Breakfast,  at  eight,  half  a  pint  of  tea  or  coffee, 
Avith  a  little  cream,  and  two  ounces  of  dry,  stale  bread.  Dinner  at  one,  two  ounces  of 
fresh  beef  or  mutton,  without  fat  or  .skin,  two  ounces  of  stale,  dry  bread,  or  well-boiled 
rice.  Three  hours  after  dinner,  half  a  pint  of  weak  brandy-and-water,  or  toast-and- 
Avater  ad  libiium.  Supper,  at  seven,  two  ounces  of  meat,  and  two  ounces  of  dry  bread. 
He  prohibits  drinking  for  an  hour  before  dinner  or  supper,  and  till  three  hours  after 
meals.  When  digestion  has  improved,  he  allows  three  ounces  of  meat  twice  a  day. 
Dr.  Salter  gives  the  following  excellent  remarks  on  the  climates  suitable  for  asthmat- 
ics:— 

(«.)  Kesidence  in  one  locality  will  radically  and  permanently  cure  asthma  resisting 
all  treatment  in  another  locality. 

{b.)  The  localities  most  beneficial  to  the  largest  number  of  cases  are  large,  populous 
and  smoky  cities. 

(c.)  That  this  effect  of  locality  depends  probably  on  the  air. 

(d.)  That  the  air  which  would  lie  imagined  to  be  the  worst  for  the  general  health 
is,  as  a  rule,  the  best  for  asthma;  thus  the  worst  parts  of  cities  are  the  best,  and  con- 
versely. 

(e.)  This  is  not  always  the  case,  the  very  reverse  being  sometimes  so. 

(/".)  That  there  is  no  end  to  tlie  apparent  caprice  of  asthma  in  this  respect. 


326  IPECACUANHA. 

(l.)  That  possibly  there  is  no  case  of  asthma  that  might  not  be  cured  if  the  right  «Ir 
could  be  found. 

(m.)  That  the  disposition  is  not  eradicated,  l)ut  merely  suspended. 

Bruntoii  states  that  emetine  hypodermically  injected  paralyzes  the 
vessels  and  greatly  lowers  arterial  pressure  even  whilst  the  heart  contracts 
strongly,  next  it  paralyzes  the  heart,  arresting  it  in  diastole.  This  state- 
ment is  in  opposition  to  the  result  Dr.  Duckworth  obtained  in  his  experi- 
ments. 

In  many  cases  of  whooping  -cough  ipecacuanha  will  often  lessen  the 
severity  and  frequency  of  the  paroxysms,  and  frecfuently  arrest  the  at- 
tendant vomiting.  Dr.  Philips,  and  some  other  observers,  consider  ipe- 
cacuanha especially  useful  when  the  attacks  of  coughing  are  accompanied 
by  retching  and  vomiting.  Like  other  whooping-cough  remedies,  ipe- 
cacuanha often  fails  in  cases  apparently  in  all  respects  similar  to  those  it 
benefits,  and  in  certain  epidemics  it  appears  to  be  all  but  useless. 

It  is  also  supposed  to  be  a  diaphoretic.  Of  course  it  excites  sweating 
when  it  excites  nausea;  but  even  irrespective  of  this  condition  it  may 
perhaps  be  a  diaphoretic. 

It  has  been  highly  praised  for  its  efl&cacy  in  haemorrhages,  as  in  epi- 
staxis,'  bleeding  from  the  lungs  or  womb,  and  the  flooding  after  delivery. 
Some  of  its  advocates  give  even  drachm  doses  of  the  powder. 

In  flooding  after  delivery  Higginbotham  recommends  ipecacuanha  in 
quantity  sufficient  to  produce  vomiting,  and  to  this  effect  he  ascribes  its 
great  efficacy  in  arresting  hemorrhage.  In  his  hands  this  treatment  suc- 
ceeded in  the  most  desperate  flooding  cases;  but  it  may  well  be  doubted 
whether,  beyond  its  emetic  efl^cct,  ipecacuanha  exerts  any  influence  over 
uterine  ha^moVrhage.  Zinc  would  probably  answer  equally  well.  Dr. 
George  Bird  tells  me  that  he  once  Avitnessed,  in  the  case  of  a  Syrian 
Jewess,  the  prompt  suppression  of  flooding  by  the  nurse,  Avho  crammed 
down  the  patient's  throat  a  handful  of  her  hair.  Probably  the  mechani- 
cal excitation  of  vomiting  would  prove  useful  in  flooding. 

Ipecacuanha,  acts  more  surely  as  an  emetic  when  given  in  divided 
doses,  at  short  intervals;  as  five  grains  in  a  little  warm  water  every  five 
or  ten  minutes. 

^Dr.  Martin,  of  Geneva,  arrests  epistaxis  (the  blood  generally  coming  from  one 
nostril)  by  compressing  the  facial  artery  of  tlie  side  upon  the  upper  jaw,  near  the 
nose,  thus  lessening  the  supply  of  blood  to  the  nose. 


VERATRUM    VIRIDE.  327 


APOMOEPHIA  , 

was  obtained  by  Matliieson  and*  Wright  and  first  tested  experimentally 
by  Dr.  Gee,  who  discovered  it  to  be  a  very  prompt  and  certain  emetic. 

It  first  excites  the  cerebrum,  producing  delirum,  and  then  paralyzes  it. 

Reichert  finds  that  the  sensory  and  motor  nerves  are  first  stimulated 
and  then  paralyzed.  According  to  Reichert  and  Harnsch  apomorphia 
is  a  muscle  poison.  It  paralyzes  the  heart,  and  first  stimulates  and  then 
depresses  the  vaso-motor  centre,  and  thus  reduces  arterial  pressure 
(Reichert).  A  large  dose  first  accelerates  and  then  slows  the  heart.  It 
increases  the  frequency  of  respiration,  which  afterwards  grows  very 
shallow  and  unfrequent;  this  e:ffect  is  due  to  the  action  of  the  drug  on 
the  respiratory  centre. 

It  readily  excites  vomiting  without  nausea,  a  tenth  of  a  grain  given 
hypodermically  acting  often  in  one  or  two  minutes.  It  acts  probably 
on  the  centre  for  vomiting.     It  increases  the  bronchial  secretion. 

It  is  used  hypodermically  chiefly  in  cases  of  poisoning  when  it  is 
necessary  to  produce  prompt  and  certain  vomiting,  as  in  cases  of  drunk- 
enness, opium  poisoning,  etc.  In  such  case  one-fourth  of  a  grain  should 
be  employed.     It  sometimes  dangerously  depresses  children. 

It  is  useful  in  some  hysterical  affections. 

It  cured  a  case  of  persistent  hiccup  when  hypodermic  injection  of 
morphia  and  atropia  had  failed. 

Weill  confirms  Gee  that  it  is  useful  in  chorea,  Ludwig  and  Burg- 
meister  show  that  apomorphia  is  a  topical  anaesthetic,  as  far  as  the  eye 
is  concerned,  equal  to  cocaine,  but  it  induces  vomiting  and  salivation 
by  absorption.  Six  to  twelve  drops  of  two  per  cent,  solution  are  need- 
ful.    The  application  is  painful. 


VERATRUM  VIRIDE 

contains  several  alkaloids,  chiefly  jervia  and  veratroidia  (now  shown 
to  be  a  mixture  of  alkaloids  and  resin),  and  these  differ  somewhat  in 
their  physiological  action.  The  action  of  these  alkaloids  has  been  elabo- 
rately studied  by  Professor  H.  Wood. 

In  small  dose  the  crude  drug  first  reduces  the  force  with  much  dim- 
inution in  the  frequency  of  the  pulse,  which  then  grows  unfrequent,  and 
may  fall  to  half  its  natural  number.  At  this  time  exertion  induces  very 
great  frequency,  the  pulse  becoming  feeble,  thready,  even  imperceptible. 
A  poisonous  dose  induces  a  very  rapid  thready  pulse,  cold  clammy  skin, 
nausea  and  vomiting,  great  muscular  prostration  and  partial  uncon- 
sciousness. 

Wood  finds  that  jervia  directly  ^affects  the  heart,  either  through  its 
ganglia  or  by  its  action  on  the  muscular  substance.  It  powerfully  de- 
presses the  vaso-motor  centre,  and  the  spinal  cord.     Veratroidia  is  more 


328  VER  ATRIA. 

irritating  than  jcrvia,  and  induces  vomiting  and  occasionally  purging, 
though  the  muscular  twitchings  and  convulsions  are  less.  It  differs 
from  jervia  in  powerfully  paralyzing  the  respiratory  centre;  hence  after 
poisoning,  unless  artificial  respiration  is  maintained,  arterial  pressure 
becomes  greatly  heightened ;  but  with  artificial  respiration,  arterial  press- 
ure steadily  falls  as  it  does  with  Jervia.  Wood,  speaking  of  the  crude 
drug,  says,  "  veratrum  viride  is  a  powerful  spinal  and  arterial  depressant, 
exerting  little  or  no  influence  upon  the  cerebral  centre.  In  full  thera- 
peutic doses  it  lowers  the  pulse  rate,  both  by  a  direct  action  on  the 
muscle  (jervia),  and  by  stimulating  the  inhibitory  nerves  (veratroidia); 
it  diminishes  the  force  of  the  heart's  beat  by  a  direct  influence  on  the 
cardiac  muscle  (jervia),  and  produces  a  general  vaso-motor  paralysis 
(jervia)." 

\eratrum  has  been  said  to  lower  the  temperature  in  health;  but, 
according  to  the  late  Dr.  Squarey's  observations,  this  is  not  the  case. 

Veratrum  viride  has  been  employed  in  the  convulsions  of  children, 
chorea,  typhoid  fever,  scarlet  fever,  measles,  pneumonia,  and  pleurisy. 
In  regard  to  pneumonia  and  pleurisy,  some  authorities  consider  that 
veratrum  is  useful  only  in  the  asthenic  forms,  acting  then  like  tartar- 
emetic  or  aconite;  others,  however,  as  confidently  recommend  this 
remedy  in  the  asthenic  forms.  The  tincture  of  veratrum  viride  should 
be  used,  since  veratria  does  not  produce  the  same  effects. 

In  the  treatment  of  the  foregoing  diseases  it  is  better  to  give  small 
doses,  as  one  or  two  minims  every  hour,  rather  than  larger  ones  at  longer 
intervals.  It  is  requisite  to  augment  the  dose  gradually  in  order  to  keep 
the  pulse  down,  otherwise  it  will  sometimes  suddenly  rise  to  1.20  or  140 
beats,  Avhich,  liowever,  may  be  reduced  again  in  a  few  hours  by  a  small 
increase  of  the  dose. 

Veratrum  is  said  to  be  efficacious  in  removing  the  pain  of  acute 
rheumatism,  and  in  controlling  and  shortening  the  fever.  It  is  also  said 
to  be  of  service  in  neuralgia,  sciatica,  and  lumbago,  and  in  the  "  con- 
gestive headache  "  which  occurs  at  the  menstrual  j)eriocl. 

Veratrum  album  has  been  used  with  success  in  the  vomiting  and 
purging  of  summer  diarrhoea. 

Veratrum  viride  is  now  very  little  used,  hence  it  is  probable  that  the 
accounts  of  its  usefulness  were  very  much  overdrawn. 


VERATRIA. 


This  alkaloid  is  obtained  from  the  seeds  of  veratrum  sabadilla. 

Veratria  (from  sabadilla  seeds)  is  an  irritant,  and  excites  sneezing, 
vomiting,  purging,  violent  twitchings,  and  convulsions,  and  afterwards 
great  muscular  Aveakness  with  loss  of  electric  irritability.  The  pulse 
at  first  is  quickened  and  strengthened,  then  slowed,  and  afterwards  be- 
comes quick,  weak,  and  irregular.  The  twitchings  and  convulsions  are 
probably  in  part  due  to  the  effect  of  the  veratria  on  the  muscles,  and 
partly  on  the  cord. 

The  twitchings  and  convulsions  are  not  jirodueed  by  the  action  of 


VERATRIA.  329 

veratria  on  the  brain,  as  they  occur  after  section  of  the  spinal  cord. 
They  are  partly  clue  to  the  direct  action  on  the  muscles,  for  they  take 
place  when  the  cord  is  destroyed,  and  in  animals  whose  nerves  are  paral- 
yzed by  curare. 

Veratria  is  a  powerful  muscle  poison,  and  curiously  affects  the  char- 
acter of  the  contraction,  acting  in  this  respect  much  like  calcium  salts 
and  alkaline  soda  salts,  as  phosphate  of  soda  and  sodium  bicarbonate;  on 
stimulation  the  muscle  contracts  anil  relaxes,  or  partially  relaxes,  like  a 
normal  muscle,  but  then  rapidly  contracts  again  and  becomes  very  slowly 
relaxed.  On  repeating  the  stimulation  this  effect  of  veratria  speedily 
ceases,  and  some  time  must  be  allowed  before  the  muscle  regains  its 
original  condition.  This  affection  of  the  muscle  causes  the  movements 
of  the  animal  to  be  stiff  and  awkward.  Sometimes  the  muscular  con- 
traction persists  so  long  as  to  suggest  tetanus  of  the  cord,  as  after 
strychnia,  but  that  this  effect  of  veratria  on  the  muscle  occurs  when  the 
limb  is  separated  from  the  trunk.  In  frogs  under  the  influence  of  vera- 
tria marked  fibrillary  contractions  occur,  looking  much  like  the  fibril- 
lary contractions  in  progressive  muscular  atrojjhy.  These  fibrillary 
contractions  in  the  frog  must  be  due  to  the  action  of  the  poison  either 
on  the  muscle  or  on  the  motor  nerves,  for  they  occur  in  an  amputated 
limb  on  stimulating  the  nerve.  Since  they  almost  disappear  when 
curare  is  administered,  these  twitchings  are  probably  due  to  some  altera- 
tion in  the  motor  nerves. 

Veratria  affects  the  cardiac  muscle  much  as  it  does  the  skeletal 
muscle,  but  is  less  poisonous  to  the  heart  than  to  voluntary  muscle.  In  a 
cardiac  contraction  it  greatly  delays  diastolic  dilatation,  also  resj^iration, 
and  induces  irregular  rhythm. 

Veratria  ointment  excites  a  sensation  of  warmth  and  pricking,  fol- 
lowed by  coldness.  Unless  applied  for  some  time  it  does  2iot  excite  in- 
flammation, but  it  then  produces  a  red  itching  rash.  It  is  a  very 
efficacious  remedy  in  neuralgia,  and,  like  aconite,  has  most  influence 
over  neuralgia  of  the  fifth  nerve.  An  ointment  of  the  Pharmacoijoeial 
strength  is  generally  strong  enough  when  applied  to  the  face,  but  in 
other  neuralgias  a  stronger  ointment  is  required. 

Dr.  Turn  bull,  who  largely  employed  veratria  ointment,  used  a  prep- 
aration containing  twenty  and  sometimes  even  forty  grains  to  the  ounce. 
These  strong  ointments  not  uncommonly  prove  very  useful  in  sciatica 
when  rubbed  along  the  course  of  pain  for  twenty  minutes  to  half  an 
hour,  twice  or  three  times  a  day.  This  strong  ointment  is  sometimes 
useful  in  the  neuralgic  pain  consequent  upon  shingles.  The  suscejiti- 
bility  to  its  action  varies;  thus,  in  some  persons,  it  readily  produces 
numbness  and  a  sensation  of  coldness,  which  may  last  several  days. 

Like  aconitia  ointment,  it  is  useful  in  sick  headache,  where  the  pain 
is  accompanied  and  followed  by  tenderness  of  the  skin.  It  should  be 
well  rubbed  over  the  seat  of  pain  on  the  very  commencement  of  the 
attack.  It  excites  less  irritation,  and  sometimes  succeeds  better  than 
the  aconite,  sometimes  very  quickly  subduing  the  pain,  preventing  the 
vomiting,  and  reducing  the  duration  of  an  attack  to  one  or  two  hours, 
or  even  to  a  few  minutes,  wlyle  previous  to  the  veratria  treatment  it 
used  to  last  one,  two,  or  three  days. 

Dr.  Turnbull  used  a  strong  ointment  to  rheumatic  joints,  and  no 
doubt  it  relieves  some  cases,  although,  unfortunately,  it  more  generally 
fails. 


330  coLCHicmr. 

Turnbiill  also  applied  the  ointment  to  the  chest  of  patients  suffering 
from  heart  disease,  with  ra})id,  irregular  pulse,  hurried  breathing,  much 
lividity  and  dropsy,  palpitation  and  inability  to  lie  down — to  cases  in- 
deed usually  benefited  by  digitalis.  These  symptoms  the  ointment  not 
uncommonly  relieved,  the  patients  passing  a  large  quantity  of  urine, 
even  six  pints  a  day.  He  likewise  employed  a  strong  ointment  to  the 
j)ainful  joints  at  the  onset  of  an  attack  of  gout.  Care  must  be  taken, 
especially  with  the  stronger  ointments,  not  to  apply  them  to  the  broken 
skin,  or  they  will  excite  much  pain  and  inflammation. 

When  sniffed  up  the  nose  the  smallest  quantity  excites  violent  sneez- 
ing, sometimes  lasting  for  hours. 

The  alkaloid  passes  readily  into  the  blood,  as  is  sufficiently  proved  by 
the  symptoms  it  occasions;  dull,  heavy,  frontal  headache,  sometimes  ac- 
companied by  shooting  or  stabbing  pain  over  one  or  both  brows,  in  the 
pit  of  the  stomach,  and  at  the  region  of  the  heart.  The  heart  is  greatly 
affected;  for  the  pulse  grows  slow  and  weak,  and  may  sink  from  70  or  80 
to  40  or  35  beats  in  the  minute,  becoming  at  the  same  so  feeble  as  scarcely 
to  be  felt  at  the  wrist.  Pushed  to  the  full  extent,  this  drug  greatly 
prostrates  the  muscular  strength — to  the  extent,  perhaps,  of  rendering 
walking  impossible,  and  the  muscles  may  twitch  and  jerk  spasmodically. 
The  surface  is  bedewed  with  a  clammy  sweat,  the  features  are  pinched, 
and  there  may  be  complete  blindness  and  deafness,  but  delirium  is  rare. 
Dangerous  as  these  symptoms  appear,  yet  they  speedily  pass  away  if  the 
drug  is  discontinued.  Some  self-experimenters  have  experienced  dull 
aching  pains,  made  worse  by  movements,  and  tonic  and  atonic  contrac- 
tions of  the  muscles,  sometimes  violent,  especially  of  the  face  and  ex- 
tremities. This  substance  has  the  same  prostrating  effect  on  birds,  and 
in  America  is  sometimes  used  to  destroy  these  animals;  it  makes  them 
too  weak  to  fly,  and  thus  they  are  easily  caught;  but  if  left  awhile,  the 
effects  of  the  drug  pass  off,  and  they  escape. 


COLCHICUM. 


"While  the  physiological  effects  of  colchicum  are  very  similar  to  those  of 
veratrum,  yet  one  drug  cannot  be  therapeutically  substituted  for  the  other. 

Strong  preparations  of  colehicuniy  applied  to  the  skin,  irritate,  excite 
redness,  prickhig  and  smarting,  and  the  powder  of  colchicum  sniffed  up 
the  nose  excites  sneezing  and  watery  discharge  from  the  eyes  and  nose. 

Colchicum  is  acrid  to  the  taste,  produces  much  irritation  of  the  fauces, 
with  increase  of  saliva,  sometimes  in  such  quantity  as  might  Avell  be 
termed  salivation. 

Colchicum  is  an  irritant  to  the  stomach  and  intestines,  and  produces 
its  effects,  whether  swallowed,  or  injected  into  the  veins. 

Small  doses,  continued  for  some  time,  produce  a  coated  tongue  and 
disagreeable  taste,  impair  the  appetite,  excite  more  or  less  thirst,  with 
pain  at  the  epigastrium,  rumblings  of  the  stomach,  and  looseness  of  the 
bowels. 

Should  vomiting  occur,  the  ejected  matters  are  bilious,  or  composed  of 
mucus,  and  after  a  large  dose  may  contain  blood.  The  stools  are  soft,  or 
even  liquid,  and  of  a  high  color;  but  after  a  large  or  poisonous  quantity 
they  are  at  first  of  the  character  just  mentioned,  but  afterwards  become 


coLciiicmr.  331 

dysenteric,  consisting  of  slime  and  blood,  accompanied  witli  mucli  strain- 
ing and  Cutting  pains  in  the  belly.  Even  when  injected  under  the  skin 
colchicum  alt'ects  the  intestinal  canal  in  the  same  way. 

Colchicum  is  rarely  used  in  diseases  of  the  alimentary  canal.  It  has 
been  employed  as  a  cholagogue.  Rutherford,  in  his  recent  investigations, 
finds  that  colchicum  in  large  doses  given  to  fasting  dogs  considerably 
increases  the  biliary  secretion,  and  at  the  same  time  purges  powerfully. 

Colchicum,  it  is  supposed,  is  most  serviceable  in  both  gout  and  rheuma- 
tism when  it  purges;  but  others  hold  purgation  to  be  not  only  unneces- 
sary but  injurious;  and  there  is  no  doubt  that  colchicum  will  as  quickly 
cure  an  attack  of  gout  without  purging. 

Colchicum  quickly  enters  the  blood,  and  in  full  doses  soon  excites 
warmth  at  the  stomach,  with  a  glow  and  outbreak  of  perspiration  of  the 
whole  surface  of  the  body,  throbbing  of  the  vessels,  and  reduction  of  the 
force  and  frequency  of  the  pulse. 

Poisoning  by  this  plant,  or  its  preparations,  produces  profound  pros- 
tration, sometimes  pain  in  the  head,  pinched  features,  perspiration,  clam- 
my skin,  small,  weak,  or  intermittent  quick  pulse,  and  not  unfrequently 
strong  muscular  twitchings,  accompanied  by  pain;  indeed,  pains  have 
been  felt  in  all  the  extremities. 

Colchicum  is  said  to  cause  pain  in  the  urinary  tract,  with  smarting 
on  micturition. 

A  quantity  sufficient  to  produce  the  symptoms  just  detailed  congests 
and  inflames  the  stomach  aud  intestines. 

It  is  reputed  to  be  diuretic,  and  to  stimulate,  even  in  healthy  persons, 
the  secretion  of  a  large  quantity  of  urinary  water  and  uric  acid;  but 
these  statements  have  not  been  confirmed  by  the  observations  either  of 
Bocker  or  Garrod,  which  show  that  if  it  acts  at  all  on  the  kidneys  col- 
chicum rather  lessens  the  amount  of  excreted  water,  urea,  and  uric  acid. 

To  Dr.  Garrod  the  profession  is  indebted  for  much  information  on 
the  nature  of  gout.  This  philosophical  observer  has  shown  that  in 
gout  there  is  retention,  with  possibly  increased  formation,  of  uric  acid  in 
the  system.  From  the  urine  of  gouty  patients  very  little,  and,  in  some 
cases,  even  no  uric  acid  can  be  obtained,  while  plenty  can  be  detected  in 
their  blood.  The  urates,  thus  circulating  through  the  tissues,  are  depos- 
ited in  various  parts  of  the  body,  and  excite  active  and  painful  inflam- 
mation. 

It  is  argued,  liowever,  that  urates  are  not  deposited  in  the  cartilaginous  and  fibrous 
tissues,  for  it  is  said  if  so  they  sliould  be  more  abundant  close  to  tlie  vessels,  whilst  it 
is  well  known  that  they  are  earliest  seen,  and  exist  most  plentifully,  in  cartilages, 
near  their  synovial  surf  ace, that  is,  at  the  greatest  distance  from  the  blood-vessels.  Hence 
it  is  maintained  that  the  urates  are  not  deposited,  but  are  always  associated  in  gout 
with  much  mal-nutrition;  thus  an  excess  is  formed  of  urates  which  remain  unabsorbed. 
in  the  slightly  vascular  and  non-vascular  tissues,  and,  of  course,  accumulate  in  those 
structures  at  the  greatest  distance  from  the  vessels.  If  tliis  view  is  correct,  the  gouty 
inflammation  cannot  be  set  up  by  the  irritation  excited  during  the  deposition  of  the 
urates,  but  is  due  to  some  hitherto  undiscovered  cause. 

Colchicum,  it  is  well  known,  gives  prompt  relief  from  the  pain, 
inflammation,  and  fever  of  gout.  But  how?  Does  colchicum  cause  the 
elimination  of  uric  acid  from  the  system  through  the  kidneys,  and  so  re- 
move the  condition  on  which  the  gout  immediately  depends?  Now  Dr. 
Garrod  has  experimentally  shown  that  colchicum  exerts  no  influence  on 
the  elimination  of  uric  acid  in  gouty  people.  Colchicum  must,  therefore, 
control  gouty  inflammation  without  in  any  way  affecting  the  condition  on 


332  COLCHICUM. 

which  the  gouty  inflammation  in  the  first  instance  depends.  Hence  col- 
chicum  is  merely  palliative,  removing  for  a  time  the  patient's  sufferings, 
but,  as  experience  abundantly  proves,  in  no  way  protecting  him  from 
their  recurrence.  For  it  is  on  all  hands  accejDted  that  colchicum  is  in- 
operative to  prevent  a  return  of  the  attack;  nay,  many  who  suffer  from 
it  are  of  opinion  that,  while  the  medicine  removes  altogether  an  existing 
attack,  it  insures  the  speedy  return  of  another.  Hence  gout-ridden 
jDcople  commonly  advise  their  fellow-sufferers  to  abstain  from  colchicum. 
But  a  gout  sufferer  is  apt  to  continue  gout-engendering  habits,  and  to 
forget  that,  as  he  grows  older,  his  gouty  tendency  becomes  stronger. 

The  effect  of  colchicum  on  the  gouty  inflammation  is  very  rapid,  for 
a  large  dose  of  the  medicine,  say  a  drachm  of  the  wine,  often  removes  the 
severest  pain  in  the  course  of  one  or  two  hours,  and  soon  afterwards  the 
swelling  and  heat  subside.  Some  observations,  conducted  by  Dr.  Rick- 
ards  and  myself,  show  that,  while  the  pain  is  thus  quickly  subdued, 
the  temperature  of  the  body  falls  very  little  during  the  day,  but  on  the 
following  morning  there  is  generally  a  considerable  decline,  and  often  a 
return  to  the  healthy  temperature;  but  should  the  fall  be  postponed  a 
longer  time,  then  on  the  second  day  after  the  use  of  the  colchicum  a 
continuous  decline  of  the  temperature  takes  place,  till  all  fever  disap- 
23ears. 

There  are  two  methods  of  employing  colchicum.  Some  give  small 
doses,  others  give  a  drachm  of  the  wine,  others  even  two  drachms  at  a 
time.  The  larger  dose  sometimes  produces  sickness,  diarrhoea,  and  great 
temjiorary  weakness,  but  it  extinguishes  the  pain  at  once.  Small  doses 
give  like  results  only  after  some  days. 

Colchicum  is  sometimes  of  use  in  the  treatment  of  various  diseases 
occurring  in  gouty  joersons;  for  instance,  bronchitis,  asthma,  chronic 
urticaria  and  other  eruptions,  dyspepsia,  etc.  Colchicum  is  sometimes 
used  in  chronic  rheumatism  and  rheumatoid  arthritis,  but,  I  think,  with- 
out any  very  apparent  benefit. 

Some  persons  are  very  tolerant  of  colchicum.  To  a  gouty  patient  I 
gave  at  first  two  drachms  and  a  half  without  any  effect,  and  on  a  subse- 
quent day  four,  and  another  day  six  drachms  without  any  result.  An 
ounce  slightly  relaxed  his  bowels,  and  ten  drachms  relaxed  his  bowels 
five  times  and  caused  a  little  sickness.  IS'o  symptoms  set  in  till  ten 
hours  after  taking  the  medicine. 


PODOPHYLLUM.  333 


PODOPHYLLUM. 

Podophyllum  is  a  powerful  purgative  and  cholagogue. 

Dr.  Anstie,  wlio  has  studied  the  action  of  podophyllum  on  dogs  and 
cats,  found  that  in  from  two  to  ten  hours  after  the  injection  of  an 
alcoholic  solution  into  the  j^eritoneal  cavity,  and  after  the  effects  of  the 
alcohol  had  ceased,  podophyllum  excited  vomiting,  and  almost  incessant 
diarrhoea.  Dr.  Anstie  does  not  usually  describe  the  character  of  the 
stools,  but  in  one  experiment  he  states  that  they  consisted  of  glairy 
mucus,  and  in  two  other  experiments  the  stools  were  highly  colored 
wath  what  looked  like  bile,  Li  many  of  the  experiments  the  stools  con- 
tained blood.  The  animals  suffered  great  pain,  and  soon  became  ex- 
hausted. At  the  pos f -mortem  examination  the  oesophagus  was  healthy, 
but  the  stomach  somewhat  congested,  induced.  Dr.  Anstie  suggests,  by 
the  violent  efforts  of  vomiting.  The  small  intestines,  especially  at  the 
lower  part  of  the  duodenum,  were  intensely  congested,  and  in  some  in- 
stances the  lower  ]3art  of  the  duodenum  was  extensively  ulcerated.  The 
large  intestines  were  but  slightly  inflamed.  Although  the  injections 
were  poured  into  the  abdominal  cavity,  the  peritoneum  itself  was  not  at 
all  inflamed,  not  even  around  some  unabsorbed  granules  of  podophyllin. 
The  contents  of  the  intestines  were  liquid.  In  all  the  instances  in  which 
the  effect  of  the  medicine  on  the  heart  and  respiration  is  mentioned, 
respiration  ceased  before  the  heart  stopped. 

From  these  experiments,  it  appears  evident  that  podophyllin  has  an 
especial  affinity  for  the  small  intestines,  and  chiefly  for  the  duodenum. 

The  Edinburgh  Committee  investigated  the  action  of  podOphyllin  on 
healthy  non-fasting  dogs,  and  their  reporter,  Dr,  Hughes  Bennett, 
stated  that  doses  of  podophyllin  varying  from  two  to  eight  grains  dimin- 
ished the  solid  constituents  of  the  bile,  whether  purgation  took  place  or 
not,  and  that  doses  which  produced  purgation  lessened  both  the  fluid 
and  solid  constituents  of  the  bile,     (See  Mercury.) 

Lideed,  these  investigators  found  that  in  non-fasting  animals  all  the 
reputed  cholagogues  failed  to  increase  the  bile,  and  further,  if  they 
purged  they  even  diminished  it.  Some  experiments  by  Rohrig  on  fast- 
ing animals  being  opposed  to  these  statements  led  Dr,  Rutherford  to 
reinvestigate  this  question.  He  finds  that  podophyllin  injected  into  the 
duodenum  of  a  fasting  dog  increases  both  the  water  and  the  solid  con- 
stituents of  the  bile ;  and  this  increase  is  greater  when  the  bile  is  allowed 
to  flow  into  the  intestines  than  when  it  is  drained  off  by  a  cannula..  The 
augmentation  of  the  secretion  is  greatest  when  the  drug  does  not  purge 
severely;  indeed,  when  it  does  purge  violently  it  may  lessen  the  biliary 
secretion. 

Drs,  Rutherford  and  Vignal  confirm  Rohrig's  statements  concerning' 
the  influence  of  other  drugs  on  the  liver  secretion  in  fasting  animals. 
They  find  that  aloes,  rhubarb,  senna,  colchicum,  taraxacum  and  scam- 
mony  increase  the  biliary  secretion ;  that  podophyllin,  aloes,  rhubarb, ' 
colchicum,  and  croton  oil  are  the  most  powerful  biliary  excitants,  senna 
and  scammony  less  so ;  and  that  they  all  increase  the  water  and  the 


334  PODOi'IIYLLUM. 

solids  of  the  bile.  Taraxacum  they  find  is  only  a  feeble  hepatic  stimu- 
lant. Eutherford  thinks  they  act  directly  on  the  hepatic  eells,  and  not 
by  increasing  the  blood  supply  Eohrig  found  that  calomel  given  to 
fasting  dogs  would  not  recall  the  secretion  Avhen  the  flow  had  stopped, 
though  the  drug  would  increase  it  when  the  bile  had  only  diminished. 
Drs.  Ixutherford  and  Vignal  find,  however,  that  calomel  generally  lessens 
both  the  water  and  the  solids  of  the  biliary  secretion,  thus  affecting  alike 
fasting  and  non-fasting  animals. 

I)rs.  liutherford  and  Vignal  endeavor  to  reconcile  the  apparently 
conflicting  results  of  their  experiments  and  those  of  the  committee  pre- 
sided over  by  Dr.  Bennett. 

The  absorption  of  food,  they  say,  is  undoubtedly  followed  by  increased 
biliary  secretion.  The  purgative  probably  diminishes  the  amount  of  food 
absorbed,  seeing  that  it  tarries  a  less  time  in  the  intestines,  and  this 
Ijrobably  overbalances  in  the  course  of  the  day  the  stimulation  of  the 
liver.  ''  When  such  substances  as  podophyllin,  rhubarb,  aloes,  and  col- 
chicum  are  administered  (a)  the  liver  is  excited  to  excrete  more  bile. 
{b)  It  purgation  result,  absorption  of  biliary  matter  and  of  food  (if  diges- 
tion is  taking  place)  from  the  intestines  is  probably  diminished,  and  thus 
by  the  twofold  operation  of  increased  hepatic  action  and  diminished 
absorption  of  biliary  matter  from  the  intestine  the  blood  as  it  passes 
through  the  portal  system  is  probably  rendered  more  pure."' 

Podophvllin  produces  very  marked  effects  on  the  motions  of  children, 
with  the  following  symjDtoms: — During  the  early  months  of  life,  esj^eci- 
ally  after  a  previous  attack  of  diarrhoea,  obstinate  constipation  may 
occur,  with  very  hard  motions,  crumbling  when  broken,  and  of  a  clay 
color,  often  mottled  with  green.  Sometimes,  at  each  evacuation,  the 
passage  of  the  hard  stools  through  the  sphincter  of  the  rectum  occasions 
greatpain,  causiijg  the  child  to  scream.  At  the  same  time  there  may 
be  much  flatulent  distension  of  the  belly,  which  excites  frequent  colic, 
this  in  its  turn  making  the  child  cry,  often  without  cessation.  This 
morbid  condition  of  the  motions  is  frequently  observed  in  children  one 
or  two  months  old,  who  are  fed  instead  of  suckled.  I  know  nothing  so 
effectual  in  bringing  back  the  projier  consistence  and  yellow  color  to  the 
motions  as  podophjdlin.  A  grain  of  the  resin  should  be  dissolved  in  a 
drachm  of  alcohol,  and  of  this  solution  one  or  two  drops  given  to  the 
child  on  a  lump  of  sugar,  tAvice  or  three  times  a  day.  The  quantity 
administered  must  be  regulated  by  the  obstinacy  of  the  bowels,  which 
should  be  kept  open  once  or  twice  a  day.  Under  this  treatment  the 
motions  often  immediately  become  natural,  the  flatulent  distension  of 
the  belly  gives  way,  and  the  child  quickly  improves.  The  restoration  of 
the  color  of  the  motions  is  j^robably  owing  to  the  increased  secretion  of 
bile  induced  by  the  podophyllin. 

That  disagreeable  cankery  taste,  unconnected  with  excess  in  alcoholic 
drinks,  generally  occurring  only  in  the  morning,  but  sometimes  con- 
tinuing in  a  less  degree  all  day,  gives  Avay  usually  to  podophyllin ;  aiid, 
if  it  fails,  mercury  generally  answers.  This  symptom,  it  is  true,  wlien 
due  to  constipation,  is  removable  by  many  purgatives,  but  podophyllin 
and  mercury  answer  best. 

In  small  doses,  h  or  i  of  a  grain,  night  and  morning,  podojdiylliu  is 
useful  in  cases  like  the  following: — A  busy,  Avorried,  over-worked  man, 
who  takes  perhaps  too  little  exercise,  feels  all  day,  but  especially  in  the 


PODOPIIYLLU:\I.  660 

morning,  dull  and  depressed,  his  mind  inactive  and  indolent,  and  he  is 
irritable.  He  has,  perhaps,  a  stupid  feeling.  He  is  often  bilious-look- 
ing, and  is  dark  around  his  eyes.  JSTow  these  symptoms,  no  doubt,  often 
accompany  sluggish  bowels,  and  can  be  relieved  by  any  purgative,  but 
they  not  uncommonly  occur  when  the  bowels  are  regular,  and  the 
motions  natural  in  color.  In  such  a  case,  a  small  non-purgative  dose  of 
podo2)h3dlin  is  most  serviceable.  The  resin  may  be  made  into  small 
pills,  or  dissolved  in  rectified  sjnrits  in  the  proportion  of  one  grain  to 
two  drachms  of  spirits,  and  six  minims  of  this  mixture  should  be  taken 
night  and  morning  in  tea  or  coffee. 

Small  doses  of  podophyllin  are  highly  useful  in  some  forms  of  chronic 
diarrhoea.  Thus  a  diarrhoea  with  highly-colored  motions  with  cutting 
pains  is  generally  relieved  by  small  doses  of  podophyllin,  the  bowels  be- 
coming regular,  and  the  pain  speedily  subsiding;  and  this  medicine  is 
especially  indicated  if  this  form  of  diarrhoea  occur  in  the  early  morning, 
compelling  the  patient  to  leave  his  bed  several  times,, but  improving 
after  breakfast,  or  by  the  middle  of  the  day;  or  sometimes  diarrhoea 
does  not  occur  after  breakfast,  but  returns  early  next  morning.  Indeed, 
jiodophyllin  will  generally  cure  this  morniiig  diarrhoea,  even  if  the 
motions  are  irale  and  watery.  By  means  of  podophyllin  I  have  cured 
chronic  diarrhoea  of  watery,  pale,  frothy  motions,  with  severe  cutting 
pain,  even  Avhen  the  diarrhoea  has  lasted  for  many  years.  Two  or  three 
minims  of  the  solution  just  mentioned  should  be  given  three  or  four 
times  a  day. 

Podophyllin  is  very  useful  in  some  forms  of  sick  headache  (migraine). 
The  nature  and  the  order  of  the  symptoms  differ  greatly  in  different  cases 
of  sick  headache.  Some,  for  instance,  are  accompanied  by  constipation, 
others  by  diarrhoea,  and  in  each  of  these  kinds  the  stools  may  be  either 
too  light  or  too  dark  in  color.  But  there  are,  besides,  many  other  varie- 
ties of  sick  headache.  Where  the  headache  is  preceded,  accompanied,  or 
followed  by  a  dark-colored  bilious  diarrhoea,  podophyllin  generally  does 
good.  Two  or  three  minim  doses  of  the  foregoing  solution,  given  three 
times  a  day,  will  restrain  the  diarrhoea,  lighten  the  color  of  the  motions, 
and  if  the  medicine  is  persevered  with,  either  prevent  the  attacks  or 
considerably  prolong  the  intervals.  When  the  diarrhoea  is  of  a  light 
color,  and  the  motions  evidently  contain  too  little  bile,  a  hundredth  part 
of  a  grain  of  bichloride  of  mercury,  given  three  times  a  day,  is  often  very 
useful.  Again,  when  the  headache  is  accompanied  by  constipation,  and 
the  motions  are  of  a  dark,  bilious  character,  a  free  podophyllin  purge 
every  day,  or  every  alternate  day,  is  very  beneficial.  Even  in  those 
nervous  headaches  occurring  either  Just  before,  at,  or  directly  after  the 
menstrual  period,  if  associated  with  constipation  and  dark-colored  stools, 
purgative  doses  of  podophyllin  often  give  relief. 

It  is  now  generally  held  that  in  sick  headaches,  or,  as  they  are  often 
termed,  nervous  headaches,  migraine,  hemicrania,  the  origin  of  the  mis- 
chief is  situated  in  some  part  of  the  central  nervous  system,  and  there- 
fore it  is  asked — What  is  the  use  of  giving  medicine  to  act  on  the  stomach, 
liver,  or  intestines  ? 

Although  the  affection  in  migraine  is  situated  in  the  central  nervous 
system,  yet  the  affection  appears  to  be  dormant  till  roused  into  activity 
by  peripheral  or  other  exciting  causes — causes  in  many  cases  due  to  the 
stomach,  the  liver,  or  the  intestines.     In  such  cases  the  sickness,  the 


336  GUAIACUM. 

diarrhoea,  or  the  constipation  precedes  the  attack:  Avhere  these  symptoms 
accompany  or  follow  the  paroxysm,  they  may  fairly  be  considered  as  part 
of  the  attack,  depending  on  changes  occurring  in  the  central  nervous 
system.  The  treatment  of  migraine,  therefore,  falls  into  three  divisions : 
1,  removal  of  the  exciting  cause;  2,  medicines  directed  to  alter  the  con- 
dition of  the  central  nervous  system  producing  the  attack;  3,  treatment 
of  the  attack  itself. 

Where  sickness,  diarrhoea,  or  constipation  precede  the  paroxysm  they 
act  as  exciting  causes,  and  if  we  can  remove  these  symj)toms  by  the  aid 
of  mercury  or  podopbyllin,  according  to  the  foregoing  directions,  we 
prevent  the  development  of  the  attack,  or  at  all  events  render  it  milder. 
Even  when  these  symptoms  accompany  the  attack,  and  form,  therefore, 
very  probably,  an  integral  part  of  the  paroxysms,  these  remedies,  or 
others  like  nux  vomica,  acting  either  on  the  stomach,  or  liver,  may  sup- 
press the  paroxysm. 

The  injection  of  podophyllin  under  the  skin  has  been  recommended. 
It  is  readily  soluble  in  equal  parts  of  liquor  potass^e  and  water;  and,  if 
the  drug  is  pure,  the  addition  of  water  does  not  precipitate  this  solution. 
The  injection  of  this  solution  to  the  extent  of  one-third  to  one-tenth  of 
a  grain  quickly  purges,  sooner,  it  is  said,  than  when  given  by  the  stomach, 
and  it  causes  no  pain. 

Podophyllin  is  a  rather  uncertain  purgative;  thus,  a  dose  adequate 
to  purge  one  person  violently  will  be  inoperative  on  another.  Indi- 
viduardifferences  occur,  it  is  true,  with  other  purgatives,  but  the  action 
of  podophyllin  appears  more  uncertain  than  other  similarly  acting  drugs. 
Again  the"^time  it  takes  to  act  varies,  purging  some  in  a  few  hours,  whilst 
with  others  it  takes  twenty-four  hours.  Sometimes  instead  of  freely 
relieving  the  bowels  it  frets  them,  by  causing  frequent  attempts  with 
ineffectual  results.  The  pure  drug  causes  very  little  griping.  In  too 
large  doses  it  is  very  apt  to  produce  slimy  and  bloody  stools,  particularly 
in  children. 


1 


GUAIACUM. 


GuAiACUM  has  an  acrid,  pungent  taste,  and  promotes  salivary  secre- 
tion. It  excites  a  sensation  of  warmth  in  the  stomach,  and  increases  the 
gastro-intestinal  secretions.  Large  doses  excite  vomiting  and  diarrhoea. 
It  is  reputed  to  increase  the  secretion  from  the  bronchial  mucous  mem- 
brane and  from  the  skin. 

Its  usefulness  is  most  conspicuous  in  tonsillitis,  and  in  this  affection 
it  ranks  with  salicylate  of  soda  and  aconite;  being,  however,  inferior  to 
salicylate  of  soda.  "  It  is  administered  either  in  powder  or  as  tincture,  or 
in  lozenge  form.  Brunton  prefers  the  guaiacum  mixture  to  the  am- 
moniated  tincture.  The  lozenges,  taken  several  times  a  day  for  a  long 
period,  appear  to  me  to  be  useful  in  follicular  pharyngitis. 

It  is  recommended  in  rheumatic  or  neuralgic  dysmenorrhoea.  It  is 
employed,  too,  in  chronic  rheumatism,  chronic  gout,  lumbago,  sciatica, 
and  chronic  bronchitis. 


ACT^A  (cimicifuga)  racemosa.  337 


ACT^A  (CIMICIFUGA)  RACEMOSA. 

This  medicine  is  used  much  more  extensively  in  America  than  in 
England.  It  has  been  emplo3'ed  for  centuries  by  the  Indians  and  settlers 
for  chorea  and  many  uterine  diseases,  and  to  assist  the  womb  to  expel 
the  child.  Those  with  most  experience  of  this  drug  sjieak  loudly  in  its 
praise. 

It  has  been  compared  to  aconite,  by  others  to  digitalis.  It  slows  the 
heart.  Some  observers  maintaining  that  it  weakens,  others  that  it 
strengthens  each  beat,  and  heightens  arterial  tension.  In  large  doses  it 
causes  giddiness,  dilated  pu2:>iis,  sleepiness,  and  sometimes  a  good  deal 
of  headache.  It  is  recommended  for  the  dyspepsia  of  drunkards,  and 
as  an  expectorant  in  bronchitis.  It  has  been  much  commended  in  acute 
and  chronic  rheumatism,  lumbago,  sciatica,  and  myalgia.  In  lumbago 
and  sciatica  I  have  often  tried  it,  but  without  success,  though,  from  the 
strong  recommendations  of  others,  it  must  be  useful  in  some  cases.  I 
have  seen  it  very  effective  in  some  cases  of  rheumatoid  arthritis. 

According  to  American  therapeutists,  this  plant  operates  powerfully 
on  the  uterus;  its  action  on  this  organ  is  stated  to  be  very  similar  to 
that  of  ergot,  stimulating  the  contractions  of  the  parturient  uterus,  and 
hastening  the  expulsion  of  the  child.  Ergot  produces  a  continuous  con- 
traction of  the  uterus,  while  actfea,  it  is  said,  merely  strengthens,  but 
does  not  prolong  the  contractile  movements,  and  therefore  endangers 
less  the  child's  life  and  the  soft  structures  of  the  mother. 

Actrea  is  said  to  be  useful  in  expelling  the  placenta  and  in  prevent- 
ing after-pains,  but  ergot  is  preferable,  as  it  produces  more  persistent 
contractions.  Actfea  has  been  recommended  in  amenorrhoea,  dysmenor- 
rhcea,  and  in  menorrhagia.  Though  inferior  to  other  remedies,  it  cer- 
tainly controls  menorrhagia. 

Again,  actsea  racemosa,  it  is  said,  will  restore  the  secretions,  and  re- 
move the  accompanying  symptoms,  when  the  menses  are  suddenly 
checked  from  cold,  shock,  or  mental  emotion,  or  when,  from  similar 
circumstances,  the  lochia  are  suppressed,  distressing  symptoms  are  apt 
to  occur,  as  more  or  less  severe  pain  in  the  head,  in  the  back,  and  down 
the  legs,  stiff  sore  muscles,  and  bearing-down  pains. 

It  has  been  given,  too,  to  prevent  miscarriages  in  irritable  uterus  and 
prolapsus  uteri. 

Actgea  is  said  to  be  serviceable  in  that  common  and  distressing  head- 
ache occurring  in  nervous  hysterical  women,  especially  at  the  menstrual 
period,  or  Avhen  the  flow  is  too  frequent  and  too  profuse,  or  at  the 
change  of  life.  It  is  one  of  the  most  useful  remedies  for  many  of  the 
distressing  symptoms  occurring  at  the  change  of  life.  It  is  well  to 
combine  it  with  small  doses  of  tincture  of  gelsemium. 
22 


338  ACONITE. 

Actaea  is  said  to  be  effective  in  the  pleurodynia  dependent  on  uterine 
derangements,  one  among  the  many  troublesome  complaints  due  to  this 
condition. 

Sir  J.  Simpson  stated  that  acttea  is  highly  beneficial  in  the  cages  of 
women  who,  during  pregnancy  and  after  confinement,  occasionally  suffer 
from  great  mental  disturbance,  sometimes  amounting  to  madness. 

Aetata  has  been  recommended  in  the  headache  arising  from  over- 
study  or  excessive  fatigue. 

Some  extol  it  as  an  expectorant,  and  it  is  also  said  to  be  useful  in 
phthisis. 


ACONITE. 


AcON"iTE  is  used  externally  in  the  form  of  liniment  or  ointment,  to 
relieve  pain.  In  the  neuralgias,  especially  of  the  brow  or  face,  these 
applications  are  often  of  the  greatest  use  in  relieving  the  distressing 
pain,  either  permanently,  or  at  all  events  temporarily.  It  is  decidedly 
more  useful  in  facial  than  other  forms  of  neuralgia,  though  in  facial 
neuralgia  it  not  seldom  fails,  notably  in  those  severe  forms  termed  epi- 
leptiform neuralgia. 

We  are  unable  as  yet  to  predict,  with  any  certainty,  the  cases  wherein 
aconite  will  succeed  or  fail ;  this  much,  however,  is  clear,  that  neuralgias 
depending  on  diseased  bone,  or  on  tumors  pressing  on  nerves,  are  be- 
yond the  control  of  aconite ;  but  these  are  not  the  only  forms  of  neuralgia 
which  will  not  yield  to  aconite.  Facial  neuralgia  due  to  decayed  teeth 
is  often  obstinate,  yet  even  these  cases  frequently  yield  to  the  external 
application  of  strong  aconite  prejjarations.  Sometimes  a  case  Avill  re- 
quire the  assidifous  application  of  the  aconite  prej^taration  during  three 
or  four  days.  In  neuralgia,  however,  due  to  this  cause,  aconite  some- 
times quickly  loses  its  effect,  and  the  pain  returns  with  its  former  fre- 
quency and  severity. 

As  no  harm  can  follow  the  employment  of  aconite  externally,  it  should 
always  be  tried;  and  if  unsuccessful,  then  recourse  can  be  had  to  other 
modes  of  treatment.  If  aconite  will  succeed  at  all,  it  will  generally  suc- 
ceed at  once;  hence,  if  relief  does  not  come  speedily  it  is  useless  to  con- 
tinue it.  The  preparation  should  be  sufficiently  strong  to  jDroduce 
decided  numbness  and  tingling  in  the  skin. 

A  piece  of  the  ointment,  the  size  of  a  bean  or  nut,  should  be  applied 
with  friction,  which  enhances  its  efficacy.  This  quantity  should  be 
repeated  until  it  induces  a  sensation  of  tingling.  The  liniment,  applied 
with  a  brush,  may  be  mixed  with  one-half  the  quantity  of  chloroform 
liniment  to  assist  absorption. 

In  cases  where  many  branches  of  the  fifth  are  affected  it  is  often 
sufficient  to  apply  the  aconite  over  the  seat  of  the  most  intense  pain ; 
and   again,  in  cases  where  other  nerves,  like  the  great  occipital  and 


ACONITE.  889 

auriculur  nerve,  are  likewise  involved,  the  applicution  of  the  aconite 
over  tlie  branches  only  of  the  fifth  most  severely  affected,  will  often  give 
complete  relief. 

Then  we  meet  with  cases  of  which  the  following  may  be  taken  as 
a  type : — A  woman  suffers  from  severe  migraine,  preceded  by  general 
malaise,  and  a  dark  discoloration  round  the  eyes;  the  pain  affects,  per- 
\i\x])s,,  only  a  small  branch  of  the  fifth,  not  uncommonly  that  twig  situated 
near  the  outer  canthus  of  the  eye,  and  when  this  happens,  a  neighboring 
vein  often  becomes  greatly  swollen.  The  pain  lasts  with  great  severity  a 
variable  time,  extending  even  to  one,  two,  or  three  days,  accomj^anied  with 
more  or  less  severe  vomiting,  the  rejected  matter  being,  perhaps,  intensely 
acid.  As  this  pain  declines,  the  patient  feels  severe  shooting  pains 
passing  up  the  back  of  the  neck  and  head  behind  the  ear,  affording  a 
sure  indication  of  the  approaching  decline  of  the  attack;  the  secondary 
pain  lasts  three  or  four  hours,  then  ceases,  leaving  the  patient  limp  and 
weak. 

The  application  of  aconite  ointment,  or  aconite  liniment,  at  the  very 
beginning  of  the  attack,  over  the  affected  branch  of  the  fifth  nerve,  will 
cut  short  the  pain,  prevent  sickness,  and  the  occurreuce  of  the  secondary 
pain  in  the  back  of  the  neck  and  head.  In  some  cases  veratria  succeeds 
better  than  aconitia  ointment. 

When  the  auriculo-temporal  nerve  is  affected  the  salivary  secretion 
may  be  increased,  diminished,  or  altered  in  character;  and  the  secretion 
of  tears  may  be  modified  in  the  same  manner  when  certain  branches  of 
the  supra-orbital  nerve  are  affected.  The  aconite  application,  by  remov- 
ing pain,  will  restore  these  secretions  to  their  natural  state. 

While  using  these  powerful  poisonous  applications  care  should  be 
taken  not  to  rl^b  them  in  wounds  or  cracks  of  the  skin,  and  to  avoid 
contact  with  absorbent  tissues,  as  mucous  membranes  and  the  conjunc- 
tiva. Spinal  irritation,  and  intercostal  neuralgia,  and  sciatica  yield,  in 
some  instances,  to  aconite  ointment;  but  spinal  irritation  and  intercos- 
tal neuralgia  give  way  more  readily  to  belladonna  ji reparations. 

Given  internally,  aconite  at  first  induces  a  sensation  of  warmth  at  the 
pit  of  the  stomach,  and  sometimes  nausea  and  vomiting.  The  sensation 
of  warmth  spreads  over  the  body,  and  tingling  of  the  lips,  tongue,  and 
adjoining  parts  is  soon  perceived;  the  uvula  and  the  tongue  feel  as  if 
swollen  and  too  large,  and  deglutition  is  frequent.  A  large  dose  induces 
tingling  and  numbness  at  the  tips  of  the  fingers,  thence  spreading  over 
the  whole  body,  accompanied  by  diminished  sensibility,  and  some  mus- 
cular weakness,  which,  with  a  very  large  dose,  becomes  extreme,  and  is 
one  of  the  most  prominent  and  important  symptoms  of  the  drug. 

The  action  of  aconite  on  the  circulation  and  respiration  is  most 
noteworthy.  Moderate  doses  greatly  reduce  the  number  of  the  heart's, 
beats,  even  to  40  or  36  in  the  minute;  but  after  a  larger  and  dangerous 
dose,  the  pulse  beats  faster,  and  may  become  irregular;  sometimes  even 
a  small  quantity  excites  irregular  heart  action.  Whether  increased  or 
lessened  in  frequency,  the  pulse  always  loses  strength,  showing  retarda- 
tion of  the  circulation.  Dr.  Achscharumow  has  shown  that  aconite 
paralyzes  the  heart  of  frogs,  arresting  the  contraction  in  the  diastole. 
The  effects  on  respiration  are  very  similar;  moderate  doses  render  the 
breathing  slower,  but  a  large  and  poisonous  quantity  often  makes  it  short 
and  hurried. 


340  ACONITE. 

How  does  aconite  affect  the  heart  ?  It  certainly  affects  either  the 
muscular  substance,  or  the  contained  ganglia  of  the  heart.  On  this 
point  all  observers  are  agreed,  for  aconitia  affects  the  heart  after  section 
of  the  pneumogastric,  or  the  administration  of  atropia  which  paralyzes 
this  nerve;  and  it  affects  the  extirpated  heart  in  the  same  way  as  it 
affects  this  organ  in  situ. 

It  is  maintained,  however,  that  it  acts  also  through  the  pneumogas- 
tric, Boehm  and  Wartmann  believing  that  it  paralyzes  the  terminations 
of  this  nerve ;  Achscharumow  that  it  first  stimulates  the  inhibitory  centre 
of  the  pneumogastric,  and  so  slows  the  heart,  and  then  the  pneumogas- 
tric becomes  exhausted,  and  at  last  paralyzed,  and  then  the  heart  beats 
quickly  and  irregularly. 

The  heart  muscle  appears  also  to  be  affected,  for  after  death  it  fails 
to  respond  to  galvanic  stimulation. 

From  our  experiments,  Dr.  Murrell  and  I  are  led  to  conclude  that 
aconitia  paralyzes  all  tissues,  and  we  suggest,  therefore,  that  aconite 
affects  all  the  structures  of  the  heart,  first  its  ganglia,  next  its  nerves, 
and  last  its  muscular  substance. 

So  far  as  we  may  draw  a  conclusion  from  the  scanty  experimental  evi- 
dence on  the  subject,  it  appears  that  aconite  does  not  affect  the  vaso-motor 
centre  or  nerves,  and  therefore  the  lessened  arterial  pressure  it  induces  is 
due  to  its  action  on  the  heart. 

It  is  generally  held  that  aconite  affects  respiration  by  its  influence  on 
the  respiratory  centres. 

The  views  concerning  its  action  on  the  nervous  system  are  very  diverse. 
Achscharumow  concludes  that  it  paralyzes  both  the  trunk  and  termina- 
tions of  the  cerebro-spinal  motor  nerves,  but  leaves  the  muscles  unaffected. 

Boehm  and  Wartmann  conclude,  from  their  experiments,  that  aconi- 
tia first  paralyzes  the  sensory,  and  then  the  motor  part  of  the  cord. 

Liegeois  and  Hottot  believe  that  it  first  paralyzes  the  "perceptive 
centres,"  above  the  spinal  cord,  and  afterwards  the  terminations,  and 
lastly,  the  trunks  of  the  sensory  nerves. 

From  experiments  detailed  in  the  Journal  of  Plu/siology,  1878,  I  con- 
clude that  aconitia  is  a  protoplasmic  poison,  and  destroys  the  functions  of 
all  nitrogenous  tissues,  first,  of  the  central  nervous  system,  next,  of  the 
nerves,  and  last,  of  the  muscles;  but  it  has  an  especial  affinity  for  the  sen- 
sory apparatus,  paralyzing  first  the  sensor-perceptive  centre.  Aconite, 
like  tartar-emetic  and  potash  salts,  is  a  powerful  depressant,  and  we  sug- 
gest that  these  drugs  do  not  merely  depress  through  their  paralyzing  effect 
on  the  heart,  but  that  they  depress  also  by  their  poisonous  action  on  the 
central  nervous  system,  and  on  the  motor  nerves  and  muscles. 

During  the  administration  of  aconite,  cutting  pains  in  the  joints  and 
other  parts  of  the  body  are  often  complained  of,  and  sometimes  an  erup- 
tion of  itching  vesicles  breaks  out  on  the  skin.  Delirium  occurs  in  some 
cases,  but  after  fatal  doses  the  mind  often  remains  clear  to  the  last.  The 
muscular  weakness  is  extreme,  and  frequent  faintings  occur.  Blindness, 
deafness,  and  loss  of  speech  occurred  in  some  fatal  cases. 

As  aconite  diminishes  sensibility,  it  has  been  used  internally,  in  vari- 
ous painful  diseases;  but  for  the  relief  of  pain,  other  internal  remedies 
have  for  the  most  part  superseded  it. 

The  power  of  aconite  to  control  inflammation  and  subdue  the  accom- 
panying fever  is  remarkable.  It  will  sometimes  cut  short  an  inflamma- 
tion.    Though  it  Avill  not  remove  the  products  of  inflammation,  yet,  by 


ACONITE.  341 

controlling  inflammation,  aconite  will  jDreveut  their  formation,  so  saving 
the  tissues  from  further  injury. 

It  is  therefore  in  the  early  stage  of  inflammation  more  conspic- 
iiously  serviceable:  still,  although  the  disease  may  have  advanced  to 
some  extent,  and  injured  the  implicated  organs  by  the  formation  of  new 
and  diseased  products,  yet  while  the  inflammation  is  still  going  on, 
aconite  does  good ;  indeed,  its  beneficial  effects  are  often  visibly  apjDarent 
in  pharyngitis,  tonsillitis,  etc. 

The  results  of  aconite  are  most  apparent  when  the  inflammation  is  not 
extensive,  or  not  very  severe,  as  in  the  catarrh  of  children,  in  tonsillitis, 
or  in  acute  sore-throat.  In  these  comparatively  mild  diseases,  especially 
if  the  aconite  is  given  at  the  earliest  stage,  when  the  chill  is  still  on  the 
patient,  the  dry,  hot,  and  burning  skin  becomes  in  a  few  hours  comforta- 
bly moist,  and  then,  in  a  little  while,  is  bathed  in  profuse  perspiration, 
often  to  such  an  extent  that  drops  of  sweat  run  down  the  face  and  chest. 
"With  the  sweating  comes  speedy  relief  from  many  of  the  distressing  sensa- 
tions, as  restlessness,  chilliness,  heat,  and  dryness  of  the  skin,  aching 
pains  and  stiffness;  the  quickened  pulse  simultaneously  becomes  far  less 
frequent,  and  in  a  period  varying  from  twenty-four  to  forty-eight  hours 
both  pulse  and  temperature  reach  their  natural  state.  If  caught  at  the 
commencement,  a  quinzy  or  sore  throat  rarely  fails  to  succumb  in  twenty- 
four  to  forty-eight  hours.  After  the  decline  of  the  fever,  the  sweating, 
to  the  annoyance  of  the  patient,  may,  on  slight  provocation,  continue 
for  a  few  days.  If  administered  early  enough,  the  beneficial  effects  of  the 
drug  soon  become  strikingly  apparent.  Thus,  large,  livid,  red,  glazed, 
and  dry  tonsils  will  in  twenty-four  hours  present  the  aspect  indicative  of 
the  subsidence  of  the  acute  stage  of  inflammation,  the  disappearance  of 
the  swelling,  with  much  redness,  whilst  the  membrane  becomes  moist, 
and  bathed  with  mucus  or  pus.  Just  at  this  stage  some  strong  astringent, 
as  glycerine  of  tannin,  or  nitrate  of  silver,  will  remove  most  of  the  remain- 
ing diseased  appearance,  and  the  pain,  if  any  should  remain.  To  those 
who  may  not  have  tried  it,  these  visible  effects  of  aconite  on  inflamed 
tonsils,  etc.,  may  seem  exaggerations,  but  any  one  who  will  employ  the 
aconite  in  the  way  we  are  about  to  jjoint  out  can  verify  my  statement. 

Its  effects  on  catarrhal  croup,  or,  as  it  is  sometimes  termed,  spasmodic 
laryngitis,  an  hereditary  disease  often  traceable  through  several  genera- 
tions, and  leaving  the  child  when  about  eight  years  old,  are  just  as  con- 
spicuous. It  removes  the  urgent  dyspnoea  in  a  few  hours,  and  shortly 
afterwards  subdues  the  fever,  and  almost  extinguishes,  in  a  few  hours,  an 
attack  lasting  usually  three  or  four  days.  When  there  is  little  or  no 
fever,  it  apparently  checks  spasms  and  croupous  breathing,  and  in  those 
rarer  cases  where  these  symptoms  continue  after  the  subsidence  of  the 
fever.  Aconite  is  equally  serviceable  in  severe  colds,  with  much  chilliness, 
great  aching  of  the  limbs,  a  hot,  dry  skin,  and  quick  pulse. 

Aconite  is  often  of  great  service  in  an  attack  of  asthma,  with  the  fol- 
loAving  symptoms: — The  patient,  generally  a  child,  is  first  seized  with 
coryza,  accompanied,  perhaps,  with  repeated  and  severe  sneezing,  then 
the  inflammation  passes  down  to  the  lungs,  causing,  perhaps,  sore  throat 
before  the  broncliial  tubes  are  reached.  The  coryza  may  precede  the 
bronchial  symptoms  by  three  or  four  days,  ceasing  wlien  the  chest  symp- 
toms begin,  which,  in  the  early  attacks,  may  consist  only  of  cough  with 
wheezing,  and  but  little  shortness  of  breath,  with  inability  sometimes  to 


342  ACONITE. 

lie  low  at  night.  As  the  disease  advances  the  asthmatic  cliaracter  bn- 
comes  more  developed,  and  tlie  coryzul  symptoms  often  simultaneously 
decline,  till  at  last  well-marked  bronchial  asthma  becomes  established, 
without  any  preliminary  coryza,  or  the  coryzal  and  asthmatic  symptoms 
begin  simultaneously.  1  believe  that  with  children  asthma  often  begins 
in  this  way,  and  throughout  life  it  may  retain  more  or  less  of  its  coryzal 
character.  Daring  the  coryzal  stage  there  is  decided  fever,  and  then  is 
the  time  when  aconite  proves  so  serviceable,  for  given  at  the  onset  of  the 
fever  aconite  cuts  it  short,  and  arrests  the  inflammation  before  it  reaches 
the  chest,  and  in  this  way  averts  the  asthma. 

In  other  cases  of  asthma,  though  there  is  no  coryza,  the  attack  is 
ushered  in  by  chilliness  and  fever,  which  for  some  days  precedes  the 
tightness  of  breathing,  and  here  aconite,  given  at  the  very  commence- 
ment of  the  fever,  may  avert  the  attack  of  asthma. 

In  a  variety  of  the  above-described  diseases,  of  which  the  following 
account  may  be  taken  as  a  type,  aconite  is  likewise  beneficial.  A  patient 
is  very  prone  to  catch  cold  from  the  slightest  exposure  to  a  draft  or  to 
damp  cold.  The  symptoms  always  follow  a  definite  order;  the  throat, 
first  attacked,  becomes  sore,  swollen,  red,  and  beefy-looking;  the  soft  pal- 
ate, its  arches,  and  the  uvula  may  be  implicated.  The  inflammation  in 
a  very  variable  time,  sometimes  almost  at  once,  oftener  after  three,  four, 
or  five  days,  spreads  upwards  to  the  nose,  causing  coryza,  and  downwards 
to  the  chest,  producing  catarrh  and  cough.  Sometimes  the  disease  tends 
to  pass  upwards,  sometimes  downwards  to  the  chest.  In  bad  cases,  or  cases 
that  have  lasted  some  time — and  the  affection  may  harass  a  patient  for  years 
— the  aspect  of  the  throat  never  becomes  natural,  the  mucous  membrane 
always  remaining  swollen,  red,  and  beefy-looking.  Exposure  to  cold  or 
damp  intensifies  this  condition,  which  then  invades  the  nose  and  chest. 
This  condition,  if  left  unchecked,  will  induce  emphysema  towards  middle 
age,  through  the  repeated  attacks  of  pulmonary  catarrh.  In  the  throat 
stage  there  is  often  fever,  and  aconite  with  belladonna,  given  at  the  very 
outset  of  the  attack',  will  often  summarily  cut  it  short  and  prevent  the 
coryzal  and  lung  symptoms.  Applications  to  the  throat  are  very  useful 
in  this  troublesome  and  pertinacious  affection.  It  is  a  good  plan  to  "  hard- 
en" the  throat  to  diminish  its  tendency  to  catarrh,  by  the  nightly  use  of 
the  cold  wet  compress,  and  daily  swabbing  with  an  astringent  like  glycer- 
ine of  tannin.  1  have  found  the  Turkish  bath  and  the  inhalation  of  sul- 
phurous acid  and  of  carbolic  acid  useful  in  these  cases. 

In  pneumonia,  pleurisy,  and  the  graver  inflammations,  the  effects  of 
this  valuable  drug,  though  not  so  rapidly,  are  often  manifest. 

In  pericarditis,  accompanied  with  violent  throbbing  and  extreme  pain, 
aconite  will  speedily  quiet  the  undue  action,  and  so  relieve  the  pain. 

Most  observers  ascribe  its  influence  on  inflammation  to  its  action  on 
the  heart,  and  point  out,  truly  enough,  that  it  is  most  useful  in  the  sthenic 
forms  of  disease;  and,  indeed,  it  may  do  harm  unless  care  is  taken  where 
there  is  great  weakness,  with  feebly-beating  heart. 

It  appears  to  me  that  in  fevers  we  can  considerably  reduce  the  frequency  of  the 
pulse  without  lessening  tlie  rapidity  of  the  circulation.  A  moderate  dose  of  aconite, 
while  it  makes  the  pidse  less  freqiient,  renders  it  fuller,  stronger,  and  less  compressi- 
ble. This  indeed,  we  should  expect,  for  if  the  heart  does  the  same  amount  of  work, 
after  it  beats  slower,  each  individual  beat  nuisl  do  much  more  work,  so  that  if  we 
reduce  the  pulse  from  120  to  CO  the  heart  must  do  twice  as  much  work  afler  it  has  been 
slowed  by  aconite.  It  may  be  said  that  though  each  beat  is  stronger,  yet  the  heart  is 
doing  less  work  than  when  it  was  beating  quicker.     As  tending  to  su'pport  the  view 


1 


ACONITE.  343 

tliat  aconite  weakens  the  heart's  contractions,  it  must  be  admitted  that  even 
small  doses,  after  a  time,  sometimes  make  tlie  pulse  unsteady  and  even  irregular. 
I  would  suggest  whetlier  the  slowmg-  efl'ect  of  aconite  may  be  useful  by  in- 
creasing- the  heart's  period  of  rest  and  nutrition.  The  diastole  of  the  heart  occu- 
pies nineteen  out  of  twenty-four  hours,  and  is  the  period  for  rest  and  nutrition. 
Thus  when  tiie  heart  is  made  to  beat  quicker  the  acceleration  takes  place  at  the 
expense  of  the  diastole,  thus  shortening  the  recuperative  period.  By  slowing  the 
heart,  aconite  prolongs  the  diastole,  and  thus  increases  the  time  of  the  heart's 
rest  and  nutrition. 

The  method  of  employing  the  drug  has  much  to  do  with  its  efficacy. 
It  should  be  given,  as  already  stated,  without  delay,  at  the  very  onset  of 
the  disease,  every  hour  being  important.  Half  a  drop  or  a  drop  of  the 
tincture  in  a  teaspoonful  of  water  should  be  given  every  ten  minutes  or 
quarter  of  an  hour  for  two  hours  and  afterwards  hourly;  but  if  there  is 
much  prostration,  with  feeble  and  weak  piQse,  a  still  smaller  dose.  Now 
and  then  a  patient  experiences  nausea  and  even  sickness  after  each  dose. 

We  feel  constrained  to  point  out  here  the  signal  service  rendered  by  the 
thermometer  in  enabling  us  to  decide  whether  or  not  to  give  aconite.  In- 
deed, in  the  treatment  of  inflammations,  the  thermometer  and  aconite 
should  go  hand-in-hand.  If  the  symptoms  and  physical  signs  are  not  suffi- 
ciently developed  to  enable  us  to  decide  whether  or  not  an  acute  inflam- 
mation of  some  deep-seated  part  has  set  in,  the  thermometer  will  often 
clear  up  the  doubt.  No  acute  inflammation  can  exist  without  preternatu- 
ral heat.  Hence,  in  a  doubtful  case,  if  the  temperature  after  careful  in- 
vestigation, is  found  natural,  the  case  is  not  one  for  aconite;  while,  on 
the  other  hand,  if  the  other  symptoms  doubtfully  indicate  an  inflamma- 
tion, a  rise  in  the  thermometer  will  add  considerably  to  the  probability 
that  we  have  to  deal  with  an  inflammation,  and  will  indicate  the  advisa- 
bility of  employing  aconite.  Sometimes  the  throat  is  swollen,  very  red, 
and  presents  the  appearance  of  an  ordinary  sore  throat  accompanied  by 
fever,  but  fever  is  absent.  Without  the  thermometer,  we  are  unable  to 
discriminate  Avitli  certainty  these  two  kinds  of  inflamed  throat,  and  the 
inability  to  distinguish  the  one  from  the  other  has  often  led,  no  doubt, 
to  the  mistaken  use  of  aconite,  so  bringing  discredit  on  this  valuable  drug. 
The  non-febrile  form  is  affected  very  little,  if  at  all,  by  aconite. 

Again,  the  use  of  the  thermometer  after  scarlet  fever  is  very  impor- 
tant: for,  as  is  well  known,  a  patient  is  then  liable  to  acute  inflammation 
of  the  kidneys,  the  flrst  onset  of  which  is  at  once  indicated  by  a  rise  in 
the  body  temperature.  It  is  well,  therefore,  during  the  convalescent  stage, 
to  direct  the  nurse  to  take  the  temperature  night  and  morning;  and  if  tliis 
should  rise  beyond  the  healthy  standard,  she  should  at  once  give  aconite, 
so  as  not  to  allow  some  hours  to  elapse  l3efore  the  patient  can  be  visited 
by  the  medical  attendant.  The  fever,  it  is  true,  may  depend  on  some 
other  cause  than  inflammation  of  the  kidneys;  but  even  then  it  will  prob- 
ably be  inflammatory  in  character,  arising  from  gastric  catarrh,  over-feed- 
ing, and  the  like,  and  in  any  case  aconite  is  indicated. 

Aconite  does  not  shorten  the  fever  of  acute  specific  diseases,  as  scarlet 
fever,  measles,  etc. ,  but  it  has  a  beneficial  influence  in  these  diseases,  sooth- 
ing the  nervous  system  and  favoring  sleep  by  inducing  free  perspiration. 
Whether  it  can  lessen  the  severity  of  the  fever,  or  diminish  the  duration 
of  the  acute  specific  diseases,  is  doubtful;  but  there  is  no  doubt  that  it 
can  control  the  inflammatory  affections  which  often  accompany  them,  and 
which  by  their  severity  may  endanger  life.  Thus  aconite  will  moderate, 
but  neither  prevent  nor  shorten  the  course  of  the  throat  inflammation  in 


344  ACONITE. 

scarlet  fever  and  the  catarrh  and  bronchitis  in  measles,  and  in  this  indi- 
rect manner  it  may  lessen  the  height  of  the  fever. 

Aconite  proves  useless  in  certain  epidemics  of  febrile  inflammatory 
sore  throat.  These  cases  are  met  with  chiefly  during  the  prevalence  of 
scarlet  fever.  The  throat  is  much  swollen,  of  a  very  dusky  red  color,  and 
the  pulse  is  very  frequent  and  very  weak.  There  is  great  jDrostration,  and 
the  symptoms  are  of  a  marked  typhoid  character.  Here  stimulants,  with 
the  application  of  a  strong  solution  of  nitrate  of  silver,  do  most  good. 

The  thermometer,  again,  renders  notable  service  whilst  giving  aconite 
in  the  acute  specific  fevers  and  the  sore  throat  Just  described.  Under  the 
influence  of  this  drug,  the  skin  becomes  moist  and  the  pulse  falls  perhaps 
to  its  normal  state,  and  we  might  conclude  that  the  temperature  likewise 
had  become  natural,  only  the  thermometer  shows  that  it  remains  unaltered. 

Aconite  is  sometimes  of  service  in  erysipelas.  Administered  at  the 
commencement,  it  often  at  once  cuts  short  the  attack ;  and  even  when  in 
spite  of  it  the  disease  continues,  aconite  will  reduce  the  swelling  and 
hardnesSjlessen  the  redness,and  prevent  the  inflammation  from  spreading. 

In  children  after  vaccination,  perhaps  when  the  spots  have  nearly 
healed,  an  erysipelatous  redness  occasionally  appears,  spreading  over  the 
arm  and  a  great  part  of  the  trunk,  usually  ceasing  in  one  part,  then  suc- 
cessfully attacking  contiguous  parts,  and  leaving  a  yellow  discoloration  and 
desquamation.  The  redness  is  often  intense,  the  tissues  being  very  hard, 
painful,  and  shiny,  and  this  inflammation  may  continue  for  weeks.  It 
may  run  down  the  arm,  involve  the  hand,  and  implicate  the  greater  part 
of  the  chest;  or  it  may  appear  in  the  leg  and  gradually  spread  to  the  foot; 
or,  again,  it  m.ay  spread  from  the  hand  up  the  arm,  and  once  more  down 
to  the  hand,  and  this  may  be  repeated  many  times.  Sometimes  the  in- 
flammation terminates  in  small  abscesses.  In  cases  like  these,  aconite 
generally  at  once  arrests  the  inflammation;  and  even  when  it  persists  aco- 
nite renders  the  redness  less  intense,  and  the  swelling  less  hard  and  pain- 
ful. The  troublesome  inflammation  often  arising  after  the  vaccination  of 
adults  ordinarily  yields  to  aconite,  especially  if  supplemented  by  the  local 
application  of  belladonna  ointment  twice  daily. 

In  the  treatment  both  of  simple  inflammations  and  acute  specific 
diseases  aconite  may  be  appropriately  administered  in  conjunction  with 
any  other  remedy  which  may  he  indicated. 

Aconite  has  been  much  praised  by  eminent  authorities  in  the  treat- 
ment of  acute  rheumatism,  but  its  good  effects  are  not  so  apparent  as  in 
acute  inflammation.  Acute  rheumatism,  having  no  regular  course  or 
duration,  may  last  untreated  only  a  few  days,  or  may  endure  for  many 
months.  It  is  difficult,  therefore,  to  decide  Avhether,  in  certain  cases, 
the  speedy  decline  of  the  fever  is  a  natural  decline,  or  due  to  the  aconite. 
It  is  certainly  ineffectual  in  many  cases,  which  appear  to  run  their  course 
uninfluenced  by  this  drug;  so  that  it  is  still  required  to  determine  in  what 
class  of  cases  it  is  useful,  and  in  what  class  of  cases  it  is  useless.  It  often 
appears  to  be  of  service,  however,  in  subduing  the  pain  from  inflamed  and 
swollen  Joints. 

Gouty  pains  are  said  to  yield  to  this  remedy.  It  has  been  given  in 
neuralgia,  apparently  with  good  results.  Gubler,  indeed,  maintains  that 
aconitia  is  highly  useful  in  trifacial  neuralgia,  and  that  it  cures  the  most 
unpromising  cases.  He  insists  on  its  l)eing  given  in  solution,  and  begins 
with  Y^ij-th  grain  of  the  nitrite,  increasing  the  dose  till  yVth  grain  is 
reached.     This  treatment  must  be  avoided  if  the  i>atient  suffers  from  heart 


DIGITALIS.  54  O 

disease.  Seguin  confirms  this  statement,  but  points  out  that  suscepti- 
bility to  the  drug  is  greater  in  some  persons  than  in  others.  He  finds 
tliat  as  a  rule  distinct  physiological  effects  follow  -i^yth  grain  thrice  daily. 

It  has  been  elsewhere  shown  that  aconite  lessens  the  rapidity  of  the 
circulation.  It  may,  therefore,  be  used  in  all  cases  where  it  is  needful 
to  subdue  vascular  excitement;  in  fact,  it  may  be  given  in  precisely 
those  cases  which  were  formerly  treated  by  bleeding. 

In  sudden  check  of  the  menses,  as  from  cold,  aconite  will  often  restore 
the  flux,  and  thus  obviate  the  distressing  and  peculiar  train  of  symptoms 
jiroduced  by  arrested  menstruation. 

It  is  recommended  in  otitis,  and  quickly  relieves  the  pain. 

Small  doses  of  aconite,  administered  frequently,  will  often  quickly 
check  the  nose-bleeding  of  children  and  of  plethoric  people. 

Aconite  will  usually  subdue  the  "  fluttering  of  the  heart "  of  nervous 
persons,  and  also  nervous  palpitations.  More  general  treatment  is  often 
required;  but  when  the  conditions  causing  the  disturbance  are  unde- 
tectable or  irremovable,  then  aconite  may  be  usefully  employed. 

In  several  cases  I  have  seen  aconite  quiet  the  distressing  restlessness 
of  "  fidgets,"  which  affects  men  as  well  as  women,  and  have  known  a  few 
drops  at  bedtime  calm  the  patient  and  give  sound,  refreshing  sleep;  if 
one  drop  is  insufficient,  it  may  be  repeated  hourly  for  three  or  four 
hours. 

A  drop  of  tincture  of  aconite  each  hour  yields  satisfactory  results  in 
the  acute  stage  of  gonorrhoea;  and  it  is  even  said  to  remove  chordee. 


DIGITALIS  AND  ITS  PEEPARATIONS. 

Large  doses  of  digitalis  excite  nausea,  vomiting,  and  diarrhoea;  the 
matters  voided,  either  from  the  stomach  or  bowels,  being  of  a  grass-green 
color,  due  to  the  action  of  the  gastric  juice  on  some  constituent  of  the 
digitalis.     These  results  may  follow  even  a  medicinal  dose. 

The  digitaline  readily  passes  unchanged  from  the  intestines  into  the 
blood;  for  the  same  symptoms  ensue  whether  the  alkaloid  is  swallowed  or 
injected  into  the  veins. 

The  action  of  digitalis  on  the  heart  is  very  noteworthy,  and  our  knowl- 
edge of  its  influence  on  this  organ,  whether  healthy  or  diseased,  is  becom- 
ing daily  more  exact. 

A  large  class  of  poisons,  namely,  sodium  hydrate,  potassium  hydrate, 
ammonium  hydrate,  the  carbonates  and  bicarbonates  of  these  elements, 
barium  salts,  strontium  salts,  digitalin,  antiarin,  helleborein,  digitoxin, 
strophanthin,  apocyniin,  scillain,  adonidin,  oleandrin,  digitalein,  apocy- 
pein,  convallamarin,  tanghinia,  upas,  erythrophlein,  phrynin,  affect  the 
frog's  heart  much  in  the  same  way,  and  perhaps  it  is  fair  to  conclude 
that  they  act  similarly  on  the  mammalian  heart. 

When  administered  through  the  circulation,  or  especially  applied  to 
the  exposed  heart,  they  all  induce  persistent  contraction  in  the  ventricle. 
In  consequence  of  this  so-called  persistent  spasm,  contracture  or  tonicity, 
the  ventricle  expands  less  during  dilatation  and  its  capacity  is  reduced; 
while  the  systole  becomes  more  powerful  and  com])lcte.  With  this  per- 
sistent contraction  the  rhythmic  contractions  continue,  but  as  owing  to 


346  DIGITALIS. 

lessening  of  diastolic  dilatation  the  capacity  of  the  ventricle  is  dimin- 
ished, less  blood  is  propelled  with  each  systole. 

The  amount  of  persistent  contraction  is  in  proportion  to  the  dose  of 
the  drug,  and  Avith  large  quantities  the  j)ersistent  contraction  is  sufficient 
to  contract  the  ventricle  completely ;  and  then  in  default  of  dilatation 
of  course  rhythmic  action  ceases.  But  rhythmic  action  is  not  destroyed, 
for  if  the  ventricle  is  dilated  by  increasing  the  internal  pressure  rhyth- 
mic action  is  restored. 

All  the  substances  enumerated  affect  the  muscular  substances  of  the 
ventricle  directly,  for  if  topically  applied  to  a  portion  only  of  the  ven- 
tricle they  induce  persistent  contraction  in  that  part,  so  that  it  dilates 
in  a  less  degree  than  the  rest  of  the  ventricle;  and  if  the  application  is 
strong  enough,  the  part  experimented  on  may  remain  persistently  and 
fully  contracted,  whilst  the  rest  of  the  ventricle  fully  dilates. 

Digitalis  with  several  other,  and  perhaps  all  the  other  substances 
named  in  the  foregoing  paragraph,  sometimes  induces  irregular  action 
in  the  ventricle. 

The  irregularity  of  the  frog's  ventricle  consists  in  one  or  more  por- 
tions of  the  ventricle  becoming  rigid,  white,  and  contracted,  while  the 
remainder  of  the  organ  continues  to  dilate  regularly.  When  the  yielding 
portions  are  small,  a  peculiar  appearance,  as  if  the  wall  of  the  ventricle 
formed  crimson  pouches  or  protrusions,  is  produced. 

This  irregular  action  is  due  to  some  parts  of  the  ventricle  being  more 
influenced  by  the  digitalis  than  the  rest,  and  these  affected  parts  becom- 
ing persistently  contracted,  consequently  dilate  in  diastole  less  than  the 
neighboring  portions  affected  in  a  lesser  degree  by  the  digitalis. 

Digitalis  increases  the  force  of  the  heart's  contraction,  and  at  first 
reduces  the  number  of  its  beats;  but  later,  after  large  doses,  the  beats 
become  frequent,  feeble,  and  irregular. 

The  isolated  heart  of  a  frog  was  made  to  pump  serum  through  a 
glass  tube;  on  applying  digitalis  the  heart  acted  with  greater  force,  but 
larger  doses  diminished  its  power.  Finally  the  heart  stopped,  with 
every  drop  of  serum  squeezed  out  of  the  ventricles.  Each  individual 
beat  of  the  heart  was  greatly  increased  in  strength,  in  some  instances 
nearly  doubled.  The  loss  of  power  after  large  doses  appeared  to  be  due 
partly  to  the  great  slowing  of  the  heart,  partly  to  the  incompleteness  of 
the  diastole,  and  the  consequent  imperfect  filling  of  the  ventricles. 
(Boehm.) 

Messrs.  Bouley  and  Reynal,  in  giving  large  doses  of  digitalis  to  horses, 
found  the  circulation  became  more  rapid,  the  heart  beats  more  abrupt, 
their  energy  much  increased,  and  accompanied,  after  a  certain  time,  with 
vibratory  thrill,  with  a  decided  metallic  tinkling,  and,  as  poisoning  went 
on,  a  distinct  bellows  murmur  was  heard,  becoming  more  audible  on 
exertion;  the  heart  beats  then  showed  a  decided  intermittence,  and  the 
pulse  was  small,  thready,  and  intermittent. 

In  doses  less  rapidly  fatal,  there  is,  at  first  sight,  excitement  of  the 
heart,  with  a  little  quickening  of  its  beats,  then  they  soon  grow  less  fre- 
quent, and  fall  to  25  to  20  a  minute.  The  cardiac  sounds  are  more 
clearly  heard,  more  distinct  from  each  other  normally,  and  with  a  differ- 
ent rhythm,  there  being  occasionally  intermissions  occurring  regularly 
or  irregularly,  and  after  a  time  a  vibratory  thrill  is  detected,  followed 
by  a  bellows  murmur.  As  death  approaches,  the  beats  become  rapid, 
90,  100,  or  140.     Dr.   Brunton,  who  has  heard  the  blowing   murmur 


DIGITALIS.  mj 

several  times,  says  it  occurs  in  horses,  dogs,  and  in  the  human  subject, 
and  that  it  is  probably  due  to  mitral  or  tricuspid  regurgitation,  from 
irregular  contraction  of  the  columnar  earner. 

Digitalis  also  greatly  heightens  arterial  tension.  Digitalis  slows  the 
jDulse  by  stimulating  the  vagus  nucleus,  and  the  ends  of  the  nerve  in 
the  heart,  for  Boehm  finds  that  after  giving  digitalis  a  farad ic  current 
applied  to  the  vagus  induces  greater  effect  than  before  the  administra- 
tion of  it. 

The  rapid  action  of  the  heart  after  large  doses  of  digitalis  is  due  to 
the  drug  paralyzing  the  ends  of  the  vagus. 

The  greatly  increased  tension  depends  partly  on  the  increased  force 
of  the  heart's  contractions,  but  chiefly,  as  first  pointed  out  by  Brunton, 
to  contractions  of  the  arterioles. 

Traube  and  Boohm's  experiments  would  seem  to  indicate  that  digi- 
talis acts  only  through  the  vaso-motor  centre, 

I  venture,  however,  to  suggest  that  digitalis  acts  directly  on  the 
arterial  muscular  tissue. 

I.  We  have  seen  that  digitalis  (in  common  with  the  group  of  sub- 
stances I  have  enumerated)  undoubtedly  affects  directly  the  muscular 
tissue  of  the  heart,  inducing  persistent  contraction,  and  not  through  the 
agency  of  nervous  tissue;  and  it  is  presumable  that  it  will  affect  other 
muscular  tissue  in  the  same  way. 

II.  Drs.  Donaldson  and  Stevens  in  America,  and  Dr.  Sainsbury  and 
myself  simultaneously  experimented,  employing  the  same  method;  and 
we  find  that  digitalis  does  undoubtedly  cause  strong-  contraction  of  the 
blood-vessels  when  these  are  quite  cut  off  from  the  central  nervous 
system.  Hence  digitalis  must  either  act  directly  on  the  muscular 
tissue  of  the  walls  of  the  blood-vessels,  or  on  some  peripheral  nervous 
apparatus  which  governs  the  muscular  tissue  of  the  blood-vessels. 

A  poisonous  dose  of  digitalis  after  a  time  paralyzes  the  arterioles, 
which  therefore  dilate,  and  the  arterial  tension  falls. 

We  can  conceive  that  in  a  given  disease  digitalis  may  afford  relief  in 
one  of  the  five  following  ways — 

I.  By  strengthening  the  action  of  a  weak  heart. 

II.  By  reducing  the  strength  of  the  beats  of  the  heart  acting  too 
powerfully. 

III.  By  lessening  the  frequency  of  the  heart's  beats. 

IV.  By  correcting  irregular  action  of  the  heart. 

V.  By  increasing  tonicity  and  so  lessening  the  size  of  the  cavities  of 
the  heart,  thereby  reducing  the  quantity  of  blood  propelled  by  each 
contraction. 

Digitalis  is  of  especial  service  in  mitral  disease. 

It  will  often  be  found  of  eminent  service  to  a  patient  presenting  the 
following  symptoms  and  physical  signs: — There  is  dropsy,  which  may 
be  extensive;  the  breathing  in  the  earlier  stages  of  this  condition  is 
much  distressed  periodically,  and  especially  at  night ;  but  when  the  dis- 
ease reaches  its  worst  stage  the  breathing  is  continuously  bad,  although 
it  becomes  paroxysmally  worse.  The  patient  cannot  lie  down  in  bed, 
and  is  perhaps  obliged  to  sit  in  a  chair,  with  the  head  either  thrown 
back,  or  more  rarely  leaning  forward  on  the  bed,  or  some  other  support. 
The  jugular  veins  are  distended,  the  face  is  dusky  and  livid,  and  the 
pulse  very  frequent,  feeble,  fluttering,  and  irregular.  The  urine  is  very 
scanty,  high-colored,  and  deposits  copiously  on  cooling.     The  heart  is 


348  DIGITALIS. 

seen  and  felt  to  beat  over  a  too  extensive  area;  and  the  cliief  impulse  is 
sometimes  at  one  spot  of  the  chest,  and  sometimes  at  another.  The 
impulse  is  undulating,  and  the  breathing  very  irregular  and  intermittent. 
A  murmur  is  ordinarily  heard,  having  the  character  of  that  produced 
by  mitral  regurgitant  disease. 

Obstruction  to  the  passage  of  the  blood  occurs  from  the  disease  of 
the  mitral  valve;  hence  congestion  of  the  lungs,  distension  of  the  right 
ventricle,  tricuspid  regurgitation,  with  general  venous  distension.  In 
fact,  there  occurs  heightened  venous  tension,  with  corresponding  dimin- 
ished arterial  tension,  the  diminished  arterial  tension  causing  diminished 
pressure  in  the  renal  glomeruli,  and  this,  conjoined  with  the  slow  circu- 
lation, leads  to  diminished  excretion  of  urine,  and  so  produces  hydrgemia, 
and  this,  helped  by  the  heightened  venous  tension  which  from  gravita- 
tion is  most  marked  in  the  most  dependent  parts  of  the  body,  induces 
drojDsy. 

A  case  presenting  these  symptoms  and  physical  signs  will  generally 
resjjond  quickly  and  favorably  to  digitalis. 

The  effects  on  the  pulse,  the  urine,  and  the  dropsy,  are  to  be  care- 
fully Avatched.  When  the  drug  is  projoerly  administered  the  pulse  grows 
considerably  stronger,  more  regular,  and  much  slower,  till  in  very  many 
cases  all  irregularity  ceases,  and  the  beats  become  natural  in  frequency 
and  rhythm,  with  much  increase  of  tension.  At  the  same  time  the 
urine,  which  previously  may  not  have  amounted  to  more  than  half  a 
pint  in  the  twenty-four  hours,  increases  to  one,  two,  four,  or  even  eight 
pints  a  day,  and  in  proportion  to  this  increased  flow  the  dropsy  dimin- 
ishes till  it  finally  disappears. 

Xow  this  obstruction  to  the  circulation  with  the  above  symptoms 
may  be  due  either  to  mitral  regurgitation  or  to  mitral  obstruction,  or  to 
both  combined.  Some  observers,  however,  consider  digitalis  is  beneficial 
in  mitral  obstruction,  others  more  especially  in  mitral  regurgitation.  I 
am  satisfied  I  have  seen  it  of  eminent  service  in  cases  where,  after  death, 
the  symptoms  vrere  seen  to  be  due  to  mitral  regurgitation,  and  but  little, 
if  at  all,  to  mitral  obstruction. 

How,  then,  does  digitalis  lessen  the  back  flow  of  blood  from  the  ven- 
tricle to  the  auricle  in  mitral  regurgitation  ?  The  mitral  valves  are  in- 
sufficient to  close  the  mitral  orifice  unless  the  ventricle  contracts  strongly; 
hence,  if  the  ventricle  from  weakness  or  from  containing  more  blood 
than  it  can  propel  contracts  imperfectly,  mitral  regurgitation  will  ensue 
in  proportion  to  the  insufficiency  of  the  contraction.  Further,  if  the 
left  cavities  dilat-e,  the  mitral  orifice  becomes  enlarged,  and  the  valves 
become  insufficient  to  close  the  orifice.  Xow  digitalis  may  act  in  two 
ways.  It  increases  the  amount  of  contraction,  and  in  this  way  lessens 
the  auriculo-ventricular  orifice  and  therefore  diminished  the  regurgita- 
tion permitted  by  the  retracted,  and  therefore  incompetent,  valves.  It 
also  increases  the  tonicity  of  the  heart  muscle  and  lessens  the  size  of 
the  ventricular  cavities,  and  so  constricts  the  mitral  orifice  and  lessens 
regurgitation.  I  suggest,  however,  that  a  third  explanation  is  feasible. 
In  mitral  disease  inducing  the  symptoms  previously  described,  the  heart 
generally  acts  irregularly.  It  may  be  assumed  in  these  cases  that  the 
columnse  carnefe  do  not  act  harmoniously  with  the  walls  of  the  ventricle, 
hence  from  this  want  of  co-ordination  the  closure  of  the  mitral  valve  is 
incomplete,  and  regurgitation  ensues,  or  in  the  case  of  organic  insuffici- 
ency of  the  valves  is  greatly  increased.     In  such  cases  digitalis  obviates 


DIGITALIS.  349 

the  irregular  action  of  the  heart  and  co-ordinates  its  various  parts,  and 
thus  removes  the  dynamic  regurgitation  due  to  inco-ordination.  In 
favor  of  this  view  is  the  fact  that  digitalis  is  especially  indicated  where 
the  heart's  action  is  irregular,  and  is,  in  my  experience,  much  less  service- 
able in  those  cases  of  mitral  disease  with  a  regular  acting  heart.  Further, 
the  benefit  of  digitalis  is  in  projDortion  to  its  influence  in  co-ordinating 
the  heart.  By  those  who  believe  that  digitalis  is  useful  in  mitral  stenosis, 
the  following  explanations  are  given.  The  auricle  empties  itself  into 
the  ventricle  chiefly  during  diastole,  consequently  the  longer  the  diastolic 
pause  the  greater  the  time  for  the  blood  to  flow  into  the  ventricle. 
Digitalis  slows  the  heart's  action,  and  so  prolongs  each  diastole,  and  in 
this  way  jjermits  the  auricle  to  become  more  completely  emptied,  thus 
partially  obviating  the  effects  of  mitral  obstruction,  especially  where  the 
heart  is  contracting  too  frequently,  the  increased  frequency  encroaching 
on  the  diastolic  period. 

Digitalis,  too,  may  act  by  increasing  the  force  of  the  auricular  con- 
traction; also  by  increasing  the  tonicity  of  .the  auricle,  and  thus  lessen- 
ing its  capacity,  and  so  reducing  the  quantity  of  blood  the  auricle  has  to 
propel  with  each  contraction.  Further,  over-distension  weakens  the 
contractile  force  of  an  organ,  and  by  increasing  the  tonicity  and  lessen- 
ing the  size  of  the  auricle,  this  over-distension  is  remedied  and  its  weak- 
ening effects  obviated. 

As  I  have  said,  digitalis  acts  best  when  the  heart  beats  irregularly; 
and  an  irregular  acting  heart  is  generally  an  indication  for  digitalis,  and 
certainly  when  the  irregularity  is  associated  with  mitral  disease.  Irregu- 
larity, however,  may  be  due  to  fatty  degeneration,  or  it  may  occur  in 
aortic  disease  Avith  deficient  compensation;  but  in  these  cases  I  find 
digitalis  inefficient,  either  in  removing  the  irregularity  or  in  obviating 
any  other  symptoms. 

In  treating  mitral  diseases  we  may  use  the  infusion,  the  tincture,  or 
the  powder  of  digitalis ;  all  are  serviceable ;  but  I  have  seen  cases  where 
the  infusion  has  succeeded  after  the  tincture  has  failed.  In  respect  of 
dose,  it  is  best  to  begin  with  a  moderate  dose,  say  a  drachm  of  the  in- 
fusion or  three  to  five  minims  of  tincture,  three  or  four  times  a  day,  for 
patients  differ  considerably  in  their  susceptibility  to  digitalis;  and  too 
large  a  dose  causes  much  distress  and  aggravates  the  troubles  of  the 
patient.  The  foregoing  doses  failing,  the  dose  of  course  must  be  in- 
creased; but  in  most  cases  large  doses  of  fifteen  to  twenty  minims  of 
the  tincture,  as  is  often  given,  will  be  found  quite  unnecessary.  Some- 
times a  patient  cannot  exist  Avithout  digitalis,  for,  on  discontinuing  it, 
the  heart  troubles  return,  and  he  may  be  constrained  to  continue  taking 
digitalis  for  months  or  years,  with  perhaps  a  short  intermission  from 
time  to  time. 

Most  authorities  are  agreed  that  digitalis  is  harmful  in  aortic  disease 
with  deficient  compensation.  So  long  as  compensation  is  equal  to  the 
valvular  defect,  of  course  digitalis  and  other  drugs  are  needless.  With 
aortic  regurgitation,  without  adequate  compensation,  digitalis,  unless 
given  in  small  doses  undoubtedly  in  some  cases  increases  the  distress  of 
the  patient.  This  bad  effect  is  explained  in  the  following  ways: — Digi- 
talis, as  we  have  seen,  slows  Hie  heart,  and  thereby  increases  each  dias- 
tole, and  so  prolongs  the  period  during  which  blood  can  fiow  back  from 
the  aorta  into  the  ventricle;  hence,  with  each  diastole,  the  amount  of 
regurgitant  blood  is  increased  with  an  increase  of  cardiac  distress. 


350  DIGITALIS. 

Further,  digitalis  mucli  heightens  arterial  tension,  which  will  also  in- 
crease the  rate  of  flow  of  the  blood  l3Tick  from  the  aorta  into  the  ventricle. 
Hence  some  writers  advise  that  in  cases  of  aortic  regurgitation,  where 
some  of  the  symptoms  indicate  digitalis,  it  must  be  given  in  doses  in- 
adequate to  slow  the  heart's  action.     (Foster.) 

On  the  other  hand,  Dr.  Balfour,  a  great  authority  on  such  a  point, 
speaks  very  highly  of  the  effect  of  large  doses  of  digitalis  in  aortic 
regurgitation  with  deficient  compensation.  He  gives  it  in  very  large 
doses,  of  course  watching  its  action  very  carefully;  and  he  says  he  has 
seen  very  striking  results.  Digitalis  he  thinks,  increases  the  tonicity  of 
the  heart,  and  so  lessens  the  size  of  the  dilated  left  ventricle,  and  thus 
obviates  the  bad  effects  of  dilatation. 

Many  writers  ascribe  the  good  effects  of  digitalis  in  mitral  disease  to 
its  tonic  action  on  the  heart,  meaning  thereby  that  digitalis  strengthens 
the  contractions  and  thus  assists  to  obviate  the  effects  of  deficient  com- 
pensation and  enables  the  heart  to  overcome  the  effects  of  the  valvular 
defect.  This  view  has  led  to  the  employment  of  digitalis  in  aortic  ob- 
struction with  deficient  compensation,  and  in  pulmonary  obstruction 
from  emphysema,  etc.,  inducing  distension  of  the  right  cavities  of  the 
heart.  In  such  cases  I  have  failed  to  obtain,  I  think,  any  good;  cer- 
tainly the  results  are  far  less  satisfactory  than  when  dealing  with  mitral 
disease;  and  this  is  admitted  even  by  those  who  are  most  confident  of 
the  usefulness  of  digitalis  in  aortic  obstruction  or  in  emjjhysema  with 
bronchitis. 

This  comparative  uselessness  of  digitalis  would  suggest  that  in  mitral 
disease  its  good  effects  depend  on  some  other  action  on  the  heart  than 
its  tonic  influence.  Nor  should  we  expect,  indeed,  that  digitalis  could 
act  much  through  its  influence  in  increasing  the  contractions  of  the 
heart.  With  valvular  defects  with  deficient  compensation,  when  symp- 
toms arise  they  indicate  that  the  heart  is  overworked  and  becoming  ex- 
hausted. At  such  a  juncture  to  merely  increase  the  work  of  the  heart 
would  increase  its  exhaustion,  and  though  perhaps  of  slight  temporary 
benefit,  such  a  result  must  soon  lead  to  increased  exhaustion  and  in- 
creased distress.  It  is  obvious,  therefore,  that  digitalis  must  act  mainly 
in  virtue  of  some  other  effect  than  a  mere  increase  of  the  force  of  the 
cardiac  contraction.  It  must  act  mainly  by  its  influence  on  tonicity,  or 
on  the  frequency  of  the  heart's  contraction,  or  by  removing  irregular 
inco-ordinate  action.  I  have  already  shown  how  by  reducing  the  heart's 
frequency  w^e  may  obviate  the  effects  of  mitral  obstruction,  but  this 
sloAving  of  the  heart,  Avhen  it  is  beating  Avith  great  frequency,  since  con- 
struction takes  place  during  diastole,  must  increase  repair  and  permit 
of  great  nourishment  of  the  cardiac  structures,  for  with  increased  fre- 
quency of  the  heart's  contraction,  the  diastolic  intervals  are  greatly 
encroached  upon;  hence  the  period  for  restoration  and  repair  being 
shortened  the  structures  must  become  weakened. 

We  meet  with  cases  of  the  following  kind  where  digitalis  is  often  of 
great  service.  A  patient  with  valvular  defect  suffers  but  little  so  long 
as  he  remains  quiet;  but  from  excitement,  or  more  frequently  from 
some  strong  muscular  exertion,  the  heart  becomes  greatly  embarrassed. 
Its  contractions  grow  very  frequent,  150  #0  160  jDer  minute,  very  weak 
and  very  irregular.  There  follows  much  dyspnoea,  even  orthopnoea,  with 
much  livid ity  and  jugular  distension. 

In  such  a  case  mental  excitement,  or  physical  exertion  has  accelerated 


DIGITALIS.  351 

the  circulation  quicker  than  the  blood  can  be  propelled  through  the 
constricted  valvular  orifice;  blood  accumulates  in  the  cavity  behind,  and 
by  distension  weakens  the  contractions  of  the  part  of  the  heart  behind 
the  source  of  obstruction.  In  such  a  case,  the  prompt  and  liberal  ad- 
ministration of  digitalis  will  often'  save  a  patient  from  death ;  ten  drops 
of  tincture  of  digitalis  every  hour  for  a  few  hours,  and  then  every  two 
hours,  should  be  given,  or  a  corresponding  dose  of  infusion.  In  such  a 
case  wc  can  conceive  that  the  digitalis  increases  the  cardiac  contractions, 
and  so  enables  the  blood  to  be  propelled  through  the  constricted  orifice 
in  quantity  sufficient  to  remove  the  distension  and  weakening  of  the 
cavities  behind;  or  it  may  be  that  digitalis,  increasing  the  tonicity  of 
the  heart,  lessening  the  size  of  its  cavities,  and  diminishing  the  amount 
of  blood  they  contain,  so  reduces  the  quantity  that  the  cavity  is  com- 
petent to  propel  all  it  contains  through  the  constricted  orifice,  and  hence 
the  removal  of  the  symptoms  of  obsti'uction. 

It  is  generally  held  that  digitalis  and  its  allies  are  useless  in  fatty 
heart.     This  is  in  accordance  with  my  own  experience. 

Again,  in  cases  of  the  following  kind,  I  find  the  digitalis  group  use- 
less. A  patient  suffers  from  arterio-capillary  fibrosis,  inducing  hyper- 
trophy of  the  left  ventricle.  Subsequently  the  heart  itself  becomes  the 
seat  of  fibroid  degeneration,  so  that  the  compensatory  hyj^ertrophy  is 
lost.  Then  follow  the  train  of  symptoms  occurring  in  a  weak  left  ven- 
tricle— symptoms  much  like  those  occurring  in  disease  of  the  aortic 
valves  with  deficient  compensation,  for  the  conditions  are  much  the 
same,  the  seat  of  obstruction  being  in  the  arteries  and  arterioles  instead 
of  the  aortic  valves. 

Such  cases  support  the  view  that  where  digitalis  is  useful  it  does 
not  benefit  by  virtue  of  its  power  to  increase  the  cardiac  contraction,  but 
through  some  other  effect. 

Da  Costa  strongly  recommends  digitalis  in  the  condition  termed  by 
him,  "  irritable  heart."  This  disease  occurs  frequently  among  soldiers, 
and  may  come  on  suddenly  or  gradually,  with  j^roneness  to  fatigue, 
palpitation,  and  dizziness.  It  is  characterized  by  j^ain,  generally  persis- 
tent, but  also  paroxysmally  intensified,  lacerated,  or  more  rarely  burn- 
ing or  tearing,  increased  by  exertion,  and  situated  most  frequently  over 
the  apex  of  the  heart,  sometimes  radiating  in  all  directions,  and  shoot- 
ing down  the  left  arm,  and  accomjDanied  by  hypersesthesia  of  the  cardiac 
region,  increased  by  each  attack  of  paljDitation.  The  patient  comj)lains 
also  of  palpitation,  varying  in  frequency  and  severity,  occurring  at  all 
times  of  the  day,  and  accompanied  by  much  distress  and  pain.  The 
palpitation  is  generally  brought  oj  by  exertion,  although  it  may  occur 
while  in  bed.  These  attacks  are  accompanied  by  dull  headache,  giddi- 
ness, and  dimness  of  sight.  The  violent  seizures  may  even  produce  in- 
sensibility. The  sleep  is  much  broken  and  troubled  by  disagreeable 
dreams,  and  the  patient  cannot  usually  lie  on  the  left  side.  The  pulse 
is  rapid,  varying  from  100  to  140  per  minute,  small,  compressible,  and 
sometimes  jerking,  often  irregular  in  force  and  rhythm — always  remark- 
ably affected  by  posture,  being  very  frequent  tl'hile  standing,  much 
slower  while  lying  down,  the  difference  amounting  to  from  thirty  to 
forty  beats  per  minute.  Palpitation  greatly  increases  the  frequency,  in 
one  instance  to  the  extent  of  192  beats  per  minute.  The  respirations 
are  but  little  hurried,  varying  from  twenty-four  to  thirty-four,  and  the 
patient  complains  of  ojopressed  breathing,  rendered  worse  by  an  attack 


352  DIGITALIS. 

of  palpitation.  Tlie  impulse  of  the  heart  is  extended,  but  is  "  quick, 
abrupt,  or  jerking,"  and  the  heart  may  beat  irregularly.  The  first  sound 
is  deficient  in  volume,  "feeble,  or  short  and  valvular,  like  the  second." 
Murmurs,  as  a  rule,  are  absent.  This  condition  is  produced  by  over- 
work and  fatigue,  and  is  fostered  by  depressing  influences.  It  commonly 
leads  to  hypertrophy,  when,  of  course,  the  physical  signs  are  modified. 
AVhen  the  heart  is  not  hypertrophied,  Da  Costa  found  that  tincture  of 
digitalis,  in  ten-minim  doses  thrice  daily,  quieted  the  excited  organ, 
reduced  the  frequency  of,  and  often  strengthened,  the  pulse,  and  rectified 
irregular  cardiac  action.  If  much  hypertrophy  existed,  then  digitalis 
proves  less  serviceable,  and  sometimes  failed  to  give  any  relief;  but  here 
aconite  in  three-  to  six-minim  doses  was  very  useful ;  though  in  purely 
nervous  cases  this  remedy  was  not  only  useless,  but  often  even  increased 
the  frequency  of  the  pulse.  In  much  irritability,  with  slight  hyper- 
trophy, a  combination  of  digitalis  and  aconite  did  good.  Belladonna 
was  useful  in  cases  accomi^anied  by  irregularity  of  the  pulse,  but  proved 
of  little  service  in  other  cases,  modifying  but  little  the  frequency  of  the 
23ulse.  It  was  of  no  service  in  cases  complicated  with  hypertrophy.  He 
often  continued  the  digitalis  for  months  without  producing  any  toxic 
effects.  In  addition  to  the  foregoing  treatment,  Da  Costa  employed  rest 
in  the  recumbent  posture. 

Digitalis  is  often  very  useful  in  quelling  the  attacks  of  palpitation  in 
pure  hypertrophy  of  the  heart,  which  may  be  due  to  valvular  disease, 
especially  of  the  aortic  valves,  or  to  Bright's  disease,  or  to  excessive 
muscular  exertion.  In  aortic  disease  the  hypertrophy  is  compensatory; 
hence,  in  most  cases,  especially  of  aortic  obstruction,  no  treatment  is 
needed  for  the  hypertrophy  itself. 

Sir  B.  Foster  recommends  digitalis  in  aortic  regurgitant  disease  when 
there  is  more  compensatory  hypertrophy  than  the  impediment  to  the 
circulation  requires,  indicated  by  violent  action  of  the  heart,  bounding 
vibratory  arteries  visible  all  over  the  body,  almost  constant  headache, 
flushed  face,  and  noises  in  the  ears.  Sir  Balthazar  Foster  points  out 
that  in  these  instances  the  action  of  the  medicine  must  be  watched,  for 
too  large  a  dose  may  induce  alarming  prostration,  with  aggravation  of 
the  palpitations,  effects  which  he  attributes  to  the  slowing  of  the  heart 
by  digitalis,  and  the  increase  of  the  regurgitation  at  each  diastole;  but, 
although  this  explanation  may  be  partially,  it  is  not  wholly  true,  for  the 
same  consequences  follow  too  large  a  dose  of  digitalis  in  other  forms  of 
hypertrophy  unassociated  with  valvular  disease.  In  cases  like  these,  two 
to  five  minims  of  the  tincture  is  as  much  as  can  be  tolerated.  For  the 
most  part  they  are  best  trciited  by  one  to  three  drops  of  tincture  of 
aconite,  given  thrice  daily. 

I  find  digitalis  of  conspicuous  service  in  cases  of  prostration  from 
fever,  as  typhoid  fever  or  pneumonia.  In  such  diseases  signs  of  failure 
may  show  themselves  first  in  the  nervous  system,  or  sometimes  earliest 
in  the  circulatory  system,  and  even  if  first  in  the  nervous  system  the 
heart  also  soon  grows  weak.  The  signs  of  nervous  depression  are  sleep- 
lessness, inducing  delirium  with  tremulousness  of  the  hands,  tongue, 
etc..  and  muscular  twitchings.  This  condition  is  best  treated  by  the 
early  employment  of  some  narcotic,  which,  by  inducing  sleep,  prevents 
the  other  symptoms  and  sustains  appetite,  digestion,  and  assimilation, 
and  obviates  the  need  of  cardiiic  tonics  like  alcohol,  etc.  If  untreated, 
this  condition  of  the  nervous  system  soon  induces  cardiac  failure,  unless 


DIGITALIS.  353 

as  in  some  cases  the  failure  begins  in  the  heart.  The  pulse  becomes  very- 
frequent  and  feeble,  or  even  irregular;  hypostatic  congestion  sets  in,  the 
ears,  tip  of  the  nose,  lips,  and  dependent  parts  of  the  body  become  dusky, 
and  signs  of  hypostatic  congestion  or  hvpostatic  pneumonia  arise.  If 
this  cojidition  of  the  heart  is  early  treated  by  liberal  doses  of  tincture  of 
digitiilis  the  j^ulse  becomes  greatly  reduced  in  frequency  and  may  speedily 
become  normal,  at  the  same  time  growing  fuller  and  of  higher  tension, 
and  coincident  with  these  improvements  duskiness  of  the  parts  most 
distant  from  the  heart  is  prevented  or  removed,  and  the  pain  is  carried 
safely  through  a  dangerous  condition.  I  give  ten  minims  of  the  tincture 
of  digitalis  every  two  or  three  hours,  according  to  the  urgency  of  the 
case.  Digitalis  I  find  in  such  cases  of  much  greater  benefit  than  alcohol. 
I  suggest  that  digitalis  acts  by  slowing  the  heart  and  so  prolonging  the 
diastolic  period,  and  giving  a  longer  time  for  the  nutrition  of  the 
weakened  heart  and  thus  sustaining  it. 

Digitalis  is  to  a  small  extent  a  diuretic,  acting  directly  on  the  kidneys, 
and  is  therefore  useful  in  some  cases  of  Bright's  disease.  When  it  obvi- 
ates the  effects  due  to  cardiac  disease  its  diuretic  effects  are  astonishing. 
I  find  that  the  diuretic  action  of  digitalis  is  limited  by  the  dropsy,  for 
when  dropsy  disappears,  the  remedy  no  longer  causes  an  increased  secre- 
tion of  urine.     Tliis  also  is  the  case  with  some  other  diuretics. 

How  does  digitalis,  in  certain  heart  diseases,  cause  so  great  an  in- 
crease in  the  quantity  of  urine  ?  First,  it  removes  those  kidney  condi- 
tions secondary  to  the  heart  disease,  which  diminish  the  urinary  function, 
when  the  unburdened  organ  acts  as  in  health,  and  secretes  a  natural 
quantity.  But  in  the  cases  now  referred  to  we  find  the  urine  increased, 
from  perhaps  half  a  pint  to  three,  or  four,  or  even  eight  pints  daily.  Is 
this  excess  of  urine  due  to  the  direct  action  of  digitalis  on  the  kidneys  ? 
Were  this  the  true  explanation,  then  this  excessive  secretion  should  con- 
tinue as  long  as  the  digitalis  is  administered,  but  we  find,  as  I  have  said, 
that  when  the  dropsy  has  disappeared  the  kidneys  no  longer  secrete  in 
excess.  The  copious  flow  of  the  urine  must  be  explained  by  the  fact 
that  digitalis,  by  relieving  the  heart,  checks  the  conditions  that  produce 
dropsy,  when  the  dropsical  fluid  returns  quickly  into  the  circulation, 
and  the  kidneys  eliminate  the  excessive  quantity  of  water  in  the  blood. 

How  does  digitalis  affect  the  kidneys  in  heart  disease,  thereby  in- 
creasing the  secretion  of  the  urine  ?  The  separation  of  the  water  of  the 
urine  is  effected  chiefly  through  the  Malpighian  bodies,  probably  by 
simple  filtration,  and  therefore,  the  amount  of  the  secretion  depends  on 
the  lateral  pressure  in  the  blood-vessels  of  glomeruli. 

Thus,  section  of  the  cord  below  the  medulla,  i.e.,  below  the  vaso-motor 
centre,  causes  great  dilatation  of  all  the  blood-vessels,  and  thus  produces 
general  lowering  of  the  blood-pressure.  The  diminution  of  blood-press- 
ure in  the  kidneys  is  followed  by  diminution,  and  even  arrest  of  the 
excretion  of  urine.  Section  of  the  renal  nerves  causing  wide  dilatation 
of  the  renal  vessels,  and  thus,  heightening  their  lateral  pressure,  causes 
a  great  increase  in  the  urinary  secretion. 

Now,  in  the  forms  of  cardiac  dropsy  benefited  by  digitalis,  there  is 
tricuspid  regurgitation,  causing  great  repletion  of  the  venous  system, 
with  corresponding  emptiness  of  the  arterial  system,  and  thus  arterial 
tension  is  greatly  lessened. 

Some  writers  ascribe  the  diminished  urinary  secretion  entirely  to  this 
loss  of  tension.     It  is  true  that  the  venous  engorgement  causes  disten- 
23 


/)54  DIGITALIS. 

sion  ©f  some  of  tlic  capillaries  of  the  kidneys,  and  thus  heightens  their 
tension,  and  it  might  be  expected  that  tiiis  increase  of  lateral  pressure 
would  cause  an  increase  in  the  secretion  of  the  urine.  It  is  urged  that 
the  venous  congestion  only  affects  the  capillaries  of  the  tubules,  and  does 
not  reach  the  Malpighian  bodies,  the  capillaries  of  the  tubules  prevent- 
ing this;  thus  the  blood-vessels  of  the  Malpighian  bodies,  through  which 
the  water  of  the  urine  filters,  become  partly  empty,  their  pressure  greatly 
diminished,  and  hence  the  secretion  of  the  urin-ary  water  is  diminished. 
But  is  this  statement  true  ?  Are  the  blood-vessels  of  the  glomeruli 
partially  empty  in  cases  of  tricuspid  regurgitation  and  venous  engorge- 
ment ?  To  this  question  I  should  answer,  certainly  not,  for  in  the  post- 
mortems I  have  made  these  bodies  have  always  been  greatly  enlarged 
and  engorged,  and  consequently  the  lateral  pressure  increased,  and  thus 
the  water  of  the  urine  should  be  increased.  The  diminution  of  the 
secretion  appears  to  me  to  be  due  to  the  venous  congestion.  In  tricuspid 
regurgitation  the  passage  of  blood  from  the  arteries  to  the  veins  is  very 
slow ;  it,  in  fact,  partially  stagnates.  The  blood,  on  reaching  the  glom- 
eruli, loses  much  of  its  water  by  pressure,  but,  having  reached  a  certain 
degree  of  concentration,  the  further  separation  of  water  is  much  slower. 
In  order  to  get  a  rapid  filtration  of  water  through  the  Malpighian  bodies, 
it  is  necessary  not  only  that  there  should  be  high  arterial  pressure,  but 
also  a  rapid  flow  of  blood.  It  appears  to  me  that  in  venous  engorge- 
ment, we  have  high  lateral  pressure,  but  a  slow  flow  of  blood,  and  that 
digitalis  acts  by  removing  congestion,  and  allowing  a  free  circulation 
through  the  kidneys. 

Brunton's  experiments  on  himself  show  that  large  doses  of  digitalis 
somewhat  increase  the  urinary  water,  and  to  a  less  extent  the  urinary 
solids,  lie  points  out  that  in  fatal  doses  at  the  end  of  life,  the  urinary 
secretion  may  be  greatly  diminished,  or  even  arrested,  due,  he  suggests, 
to  a  powerful  contraction  of  the  renal  vessels.  Mr.  Rose  Bradford,  in 
his  careful  experiments,  confirms  these  statements.  He  grai)hically 
recorded  variations  in  the  carotid  pressure  and  the  supply  of  blood  to 
the  kidney,  this  supply  being  estimated  by  Roy's  oncometer,  which 
records  any  variation  in  the  size,  i.e.,  the  blood  supply  of  the  kidney. 
Mr.  Bradford  finds  "that  digitalin  administered  to  cats  in  doses  of  4V  of 
a  grain  and  upwards  produces  marked  contraction  of  the  kidne3%  which 
is  very  persistent,  lasting  frequently  for  half  an  hour,  and  if  large  and 
repeated  doses  are  injected  the  kidney  does  not  recover  its  previous 
volume,  even  after  some  hours.  Simultaneously  with  this  renal  con- 
striction there  is,  as  is  well  krtown,  considerable  heightening  of  the  blood- 
pressure.  It  is  interesting  to  observe,  with  regard  to  this  drug,  that 
although  it  produces  contraction  of  the  renal  vessels,  like  the  initial 
action  of  caffeine,  unlike  caffeine,  it  does  not  cause  any  diminution  or 
arrest  of  the  urinary  secretion  during  this  period  of  contraction.  In- 
stead of  any  diminution  in  the  rate  of  urinary  flow,  this  is,  on  the  con- 
trary, slightly  increased  by  digitalin.  The  probable  explanation  of  these 
differences  lies  in  the  fact  that  whereas  caffeine  and  digitalin  both  pro- 
duce contraction  of  the  renal  vessels,  with  caffeine  the  general  blood- 
pressure  is  lowered  at  first  and  with  digitalin  it  is  raised.  Hence,  during 
the  initial  stage  of  the  action  of  caffeine  the  rate  of  flow  of  blood  through 
the  renal  vessels  is  lessened;  Avhereas  with  digitalin  this  rate  of  flow  is 
increased." 

Digitalis  hjis  been  employed  in  the  treatment  of  acute  inflammation. 


DIGITALIS.  355 

Mr.  King,  of  Siixmundham,  held  that  no  good  was  to  be  effected  in  in- 
flammation, unless  with  a  large  dose,  and  he  gave  from  half  an  ounce  to 
an  ounce  of  the  tincture;  with  these  formidable  doses  he  declared  he 
could  subdue  most  inflammations  if  attacked  at  their  very  commence- 
ment, and  before  the  organs  involved  became  disorganized.  He  admin- 
istered a  dose  and  then  waited  twenty-four  hours  to  watch  its  effects;  at 
the  expiration  of  the  time,  if  the  pulse  did  not  become  much  less  fre- 
quent or  irregular,  he  repeated  the  dose.  He  gave  as  much  as  two 
drachms  of  the  tincture  to  a  child  of  nine  months  old.  Vomiting  some- 
times quickly  follows  these  very  large  doses.  ]S"o  serious  or  dangerous 
symptoms,  says  Mr.  King,  ever  followed  his  extensive  and  startling  use 
of  digitalis. 

Dr.  Koyston  Fairbank  flnds  digitalis,  employed  both  locally  and  in- 
ternalh',  useful  in  inflammations.  He  narrates  cases  of  acute  inflamma- 
tion of  joints,  acute  inflammation  of  the  legs  from  varicose  ulcers,  severe 
inflammation  of  the  breast,  and  of  erysipelas,  yielding  speedily  to  fomen- 
tation, made  by  infusing  a  small  tea  spoonful  of  the  dried  leaves  in  half 
a  pnit  of  boiling  water,  and  apj^lied  by  means  of  flannels  wrung  out  in 
this  decoction.  Sometimes,  after  simple  hot  fomentations,  he  advises  the 
rubbing  in  of  some  tincture 

Digitalis  will  reduce  the  temperature  of  fever,  though  large  doses  are 
often  required. 

In  typhoid  fever,  Wunderlich  recommends  digitalis,  asserting  that  in 
two  or  three  days  it  will  reduce  the  temperature  of  the  body  by  2°  or  3° 
Fahr.,  and  will  slacken  the  pulse,  sometimes,  by  thirty  or  forty  beats  in 
the  minute. 

Digitalis  controls  epistaxis,  haemoptysis,  and  menorrhagia.  In  cases 
of  menorrhagia,  unconnected  Avith  organic  disease,  this  medicine,  inde- 
pendently of  the  state  of  the  circulation,  is  said  to  be  more  efficacious 
than  any  other  remedy;  and,  Avhen  organic  disease  gives  rise  to  this  form 
of  bleeding,  the  effect  of  the  medicine  is  scarcely  less  manifest,  although 
the  advantage  may  be  temporary. 

The  late  Dr.  Brinton  highly  esteemed  it  in  bleeding  from  the  lungs, 
stating  that  when  it  reduced  the  frequency  of  pulse  the  bleeding  ceased. 
The  infusion  is  to  be  preferred  for  haemorrhages,  and  large  doses  may  be 
required. 

In  rare  instances,  digitalis  occasions  great  strangury,  with  a  desire, 
almost  incessant,  to  pass  water,  accompanied  by  great  and  painful  strain- 
ing, and,  in  women,  by  strong  "  bearing-down  "  pains. 

Few  remedies  are  of  more  avail  in  arresting  sj)ermatorrhoea  than 
digitalis  in  drachm  or  two-drachm  doses  of  the  infusion  twice  or  thrice 
daily.  The  free  application  of  cold  water  to  the  testicles  and  perina?um 
aids  the  effect  of  the  medicine ;  and  it  is  a  useful  practice  to  let  the  tes- 
ticles hang  in  cold  Avater  night  and  morning  for  five  or  ten  minutes  at 
a  time. 

The  late  Mr.  Jones,  of  Jersey,  excited  considerable  astonishment  by 
the  announcement  of  the  good  effects  he  obtained  from  very  large  doses 
of  tincture  of  digitalis  in  the  treatment  of  delirium  tremens.  He  gave 
half  an  ounce  of  the  tincture,  and  repeated  it  when  necessary  in  four 
hours;  and  again  in  six  hours;  and  again  when  needful  in  two-drachm 
doses.  Mr.  Jones  says  of  this  treatment,  "  The  pulse,  so  far  from  being 
lowered  in  force,  becomes  fuller,  and  stronger,  and  more  regular  soon 
after  the  first  dose.    The  cold  clammy  perspirations  wear  off  and  the  skin 


356  DIGITALIS. 

becomes  warmer.  As  soon  as  the  remedy  produces  its  full  effect,  sleep 
for  five  or  six  hours  commonly  follows.  Hleep  is  the  guide  to  the  repeti- 
tion of  the  dose.  No  action  on  the  kidneys  is  evinced  by  an  unusual 
secretion  of  urine.  Sometimes  the  bowels  are  acted  on  slightly,  but 
not  commonly."  Mr.  Jones  never  saw  any  alarming  symptoms  follow 
these  large  doses,  although  he  treated  in  this  way  about  seventy  cases  of 
delirium  tremens.  It  would  appear  that  he  adopted  this  treatment  only 
in  the  severer  asthenic  forms  of  delirium  tremens.  With  regard  to  this 
treatment  of  delirium  tremens,  the  following  conclusions  appear  to  be 
established : 

I.  The  medicine  may  be  given  in  the  manner  directed,  without  danger. 

II.  That  it  very  often  does  good,  producing  speedily,  in  most  cases, 
refreshing,  quieting  sleep ;  and,  even  when  it  fails  to  induce  sleep,  it  gen- 
erally calms  undue  excitement. 

III.  That  some  cases  appear  to  be  uninfluenced  by  the  drug. 

It  yet  remains,  however,  to  ascertain  the  forms  of  the  disease  amen- 
able to  digitalis. 

Under  this  treatment  some  severe  asthenic  cases,  when  owing  to  great 
jDrostration  death  seemed  imminent,  have  rallied  astonishingly  and 
ultimately  recovered.  The  evidence  of  this  is  too  strong  to  be  disputed. 
Under  the  influence  of  digitalis,  the  weak,  rapid  and  fluttering  pulse 
grows  strong  and  steady,  tiie  skin  comfortably  moist  and  warm,  while, 
with  the  improvement  in  the  circulation  and  state  of  the  skin,  the  gen- 
eral condition  of  the  patient  improves.  On  the  other  hand,  it  appears 
equally  certain  that  asthenic  forms  of  the  disease  are  also  amenable  to 
this  drug;  in  several  instances  I  have  seen  this  form  of  the  disease  yield 
speedily  to  huge  doses  of  digitalis. 

I  give  a  short  account  of  a  case  of  delirium  tremens  recently  treated 
with  large  doses  of  tincture  of  digitalis.  The  man,  aged  about  50,  had 
been  a  very  hard  drinker  for  many  years.  He  was  well  nourished,  but 
his  urine  contained  a  considerable  amount  of  albumen.  After  trying 
large  doses,  of  chloral  and  bromide  of  potassium,  we  gave  him  a  grain  of 
liyoscyamia,  which  quieted  him  for  several  hours,  but  did  not  produce 
sleep,  and  as  he  was  in  no  way  benefited  by  our  treatment,  we  resolved 
to  give  him  half-ounce  doses  of  tincture  of  digitalis  according  to  Jones's 
directions.  Before  giving  him  this  first  dose  his  pulse  was  90,  regular, 
and  fairly  good ;  in  half  an  hour  the  pulse  rose  to  108.  In  three  hours^ 
time  the  digitalis  was  repeated;  in  an  hour  the  pulse  was  120;  in  three 
hours  150,  irregular;  in  four  hours  200,  very  irregular,  very  feeble: — in 
four  hours  and  a  half  it  had  fallen  to  124,  and  was  much  stronger  and 
more  regular;  during  the  height  it  varied  between  130  and  140.  Xext 
day  at  noon  it  fell  to  90,  and  was  intermittent,  but  not  irregular;  in  the 
evening  it  was  GO. 

Digitalis  is  said  to  be  cumulative.  We  meet  with  patients  who,  whilst 
taking  digitalis,  remtiin  for  many  days  but  little  affected,  and  then  sud- 
denly the  pulse  falls  to  40,  35,  or  even  to  30  beats  a  minute.  This  abrupt 
occurrence  of  toxic  symptoms  is  ascribed  to  accumulation  of  the  drug 
in  the  system,  absorption  from  the  stomach  being  more  active  than 
elimination  through  the  kidneys,  etc. ;  hence  the  digitalis  accumulates, 
in  the  blood  and  induces  this  sudden  onset  of  symptoms. 


STROPHANTHUS.  357 


CONVALLARIA  MAJALIS. 

We  now  know  a  considerable  number  of  remedies  which  affect  the 
heart  and  blood-vessels  in  the  same  way  as  digitalis,  drugs  which 
strengthen  the  rhythmic  contraction  and  tonic  contraction  of  the  heart, 
and  raise  arterial  tension,  probably  by  their  direct  action  on  the  blood- 
vessels and  not  through  the  vaso-motor  nerves. 

Convallamarin  (Convallaria  majalis),  Adonidin  (Adonis  vernalis), 
Stroplianthin  (Strophanthiis  hispidin),  first  investigated  by  Professor 
Praser  and  recommended  by  him  as  a  substitute  for  digitalis,  Erythro- 
phlffiin  (Casca)  recommended  by  Brunton,  and  Sparteine  are  the  most 
important.  While,  no  doubt,  each  of  these  is  useful,  it  remains  to  be 
seen  if  they  are  equal  or  superior  to  digitalis.  Convallaria  majalis  has 
been  the  most  studied  and  is  still  on  its  trial,  and  it  has  certainly  not 
yet  established  its  claim  to  be  considered  equal  to  digitalis.  Though 
these  substances  in  their  physiological  action  are  much  akin  to  digitalis, 
yet  they  differ  from  it  in  some  respects — for  instance,  strophanthin  is 
a  far  more  powerful  muscle  poison  than  digitalis.  It  is  certain  then 
that,  whilst  having  much  in  common,  these  drugs  play  each  a  thera- 
peutical rule  of  its  own. 

Convallaria  has  long  been  used  by  the  Russian  peasantry  for  dropsy. 
Waltz  discovered  two  alkaloids,  convallaria,  a  simple  purgative,  and 
convallamarin,  on  which  its  cardiac  and  vasculnr  action  depends. 

Toxic  doses  cause  in  frogs  jirogressive  paralysis,  muscular  tremblings, 
and  at  last  complete  loss  of  reflex  action  and  death.  Modei'ate  doses 
slow  and  strengthen  the  heart's  contractions,  larger  doses  accelerate  the 
heart  and  cause  irregularity.  Doses  that  slow  the  heart  heighten  arterial 
tension.  It  acts  directly  on  the  heart,  arresting  it  in  systole,  probably, 
like  digitalin,  affecting  the  muscular  tissue.  It  probably,  too,  acts 
directly  on  the  blood-vessels,  but  does  not  seem  to  affect  the  other  organs 
in  any  notable  degree. 

As  regards  its  therapeutic  value,  opinions  differ  greatly;  See  con- 
sidering it  superior,  other  observers  for  the  most  part  ranking  it  much 
inferior,  to  digitalis. 

It  is  well  to  point  out  that  there  is  no  officinal  preparation  of  conval- 
laria, consequently  the  preparation  of  one  pharmaceutist  is  often  much 
stronger  than  that  prepared  by  another. 


STROPHANTHUS  (KOMBI  ARROW  POISON). 

Professor  Fraser  first  investigated  this  drug  and  introduced  it 
into  medicine. 

It  has  a  bitter  taste.  At  one  time  it  was  said  not  to  derange  the 
gastro-intestinal  canal,  but  subsequent  observations  show  that  it  some- 
times causes  loathing  of  food,  nausea,  vomiting,  and  diarrhoia,  which 
may  be  violent.  In  large  doses  it  may  produce  a  sensation  of  burning 
in  the  oesophagus  and  stomach.     Where,  however,  digitalis  upsets  the 


358  SPARTEINE. 

stomach,  strophanthus  is  often  well  borne;  hence  when  digitalis  dis- 
agrees strophanthus  may  he  usefully  substituted. 

Fraser  shows  that  like  digitalis  it  poisons  striated  muscle.  In  my 
experiments  I  find  it  poisons  skeletal  more  than  cardiac  muscle.  Fraser 
finds  it  increases  the  contractile  power  of  all  striped  muscle.  It  aifects 
the  heart  in  all  resjiects  like  digitalis,  and  also  heightens  arterial  tension ; 
but  this  is  said  to  be  due  mainly  to  increased  contraction  of  the  heart, 
and  but  slightly  to  a  contraction  of  the  arterioles;  this  statement,  how- 
ever, has  been  controverted,  and  it  is  said  to  cause  marked  arteriole- 
contraction. 

Mr.  Bradford  has  tested  the  action  of  strophanthus  in  animals  on 
the  general  blood-pressure  and  especially  on  the  renal  circulation,  test- 
ing the  kidney  circulation  by  means  of  Roy's  oncometer.  He  says,  "  It 
is  well  known  from  the  work  qf  Fraser  that  strophanthus  heightens 
arterial  pressure  by  increasing  the  force  of  the  heart's  beats.  Thus  this 
drug  differs  from  digitalin  and  spartein  where  the  increased  cardiac 
action  is  accomjDanied  by  a  constriction  of  the  muscular  coat  of  the 
peripheral  vessels.  On  the  kidney,  as  investigated  by  means  of  the 
oncometer,  strophanthus  has  scarcely  any  action.  The  injection  of  the 
drug  is  followed  by  an  exceedingly  slight  and  transitory  contraction, 
lasting  but  a  few  seconds.  Further,  the  drug  does  not  increase  the  flow 
of  urine,  even  when  its  effects  on  the  blood  pressure  are  marked.  Hence 
these  results  confirm  Fraser's  view  that  the  action  of  strophanthus  on 
the  vascular  system  is  almost  limited  to  its  action  on  the  heart." 

As  Fraser  has  shown,  it  may  be  used  as  a  substitute  for  digitalis;  and 
if  it  should  prove  that  strophanthus  does  not  contract  the  arterioles, 
then  theoretically  we  should  expect  it  would  answer  better  than  digitalis, 
as  under  the  influence  of  strophanthus  the  heart  would  be  spared  the 
obstruction  caused  by  contraction  of  the  peripheral  vessels. 

At  present  its  relative  value  to  digitalis  cannot  be  decided,  but  I 
believe  that  it  is  now  generally  held  to  be  inferior  to  digitalis.  It  is 
certain  that  it  is  not  nearly  so  much  employed  as  it  was  a  little  while 
ago.  It  must,  however,  be  admitted  that  cases  occur  in  which  it  svic- 
ceeds  where  digitalis  has  failed ;  but  the  special  indications  for  the  use 
of  strophanthus  are  not  yet  ascertained. 

Drasche  found  it  greatly  relieved  palpitation  and  dyspnoea  in  failing 
heart. 

It  is  also  recommended  in  secondary  failure  of  the  heart  in  renal 
disease,  a  condition  I  do  not  find  benefited  by  digitalis. 

Sometimes,  like  digitalis,  it  causes  violent  headache.  It  is  said  not 
to  be  cumulative.  It  is  useless  in  renal  dropsy.  The  dose  recommended 
is  from  three  to  ten  minims,  but  I  do  not  often  obtain  much  benefit 
with  smaller  doses  than  five  minims  four  times  a  day. 


SPARTEINE, 


a  liquid  alkaloid  derived  from  broom,  is  highly  recommended  by  See 
as  superior  to  digitalis.  The  alkaloid  is  insoluble  in  water,  whilst  the 
sulphate  is  freely  soluble;  it  is  used  in  doses  gr.  ^  to  grs.  ij.  The 
accounts  of  its  physiological  action  are  somewhat  discrepant.     Some 


ADONiDiisr.  359 

observers  find  tliat  it  first  accelerates  the  heart,  and  this  action  is  due  to 
paralysis  of  the  vagi.  Next  it  slows  the  heart,  increasing  the  force  and 
duration  of  its  contractions.  With  full  doses  there  is  no  primary  acceler- 
ation, but  the  heart  is  at  once  slowed.  After  toxic  doses  the  pulse  is 
much  accelerated  and  becomes  irregular,  hence  in  these  respects  sparteine 
acts  like  digitalis  and  its  allies. 

It  heightens  arterial  tension.  Mr.  Bradford  finds  in  animals,  "  The 
kidney  vessels  are  constricted  by  it  to  a  marked  extent,  the  flow  of  urine 
being  considerably  diminished,  this  diminution  continuing  for  some  time 
after  the  constriction  of  the  renal  vessels  has  ceased."  It  is  therefore 
not  a  direct  diuretic. 

It  is  used  in  place  of  digitalis,  and  therefore  is  found  useful  in  mitral 
disease,  with  irregularity  of  the  heart's  action.  It  regulates  tlie  pulse, 
increases  arterial  tension,  diminishes  venous  congestion,  accelerates  the 
circulation,  and  then  acts  as  a  diuretic,  removing  dropsy,  its  diuretic 
action  being  in  proportion  to  its  influence  on  the  heart.  See  recom- 
mends it  in  all  cases  of  Aveak  heart,  or  when  compensation  is  deficient, 
but  it  is  especially  indicated  where  the  pulse  is  irregular.  See  finds  it, 
too,  useful  in  typhoid  states,  presumably  from  its  action  on  the  heart. 

See  ranks  its  efficacy  above  that  of  digitalis  or  convallamarin,  but 
most  observers  find  it  decidedly  inferior  to  digitalis. 

It  is  not,  as  we  have  seen,  a  diuretic  by  its  direct  action  on  the  kid- 
neys, hence  it  is  useless  in  renal  dropsy.  Indeed,  in  some  experiments 
on  rabbits  it  diminished  the  urinary  secretion. 

Since  its  action  is  speedier  and  less  persistent  than  that  of  digitalis, 
sparteine  is  preferable  where  a  prompt  effect  is  urgently  required. 

It  sometimes  excites  slight  diarrhoea. 


ADONIDIN. 


A  GLUCOSIDE  of  adonis  vernalis,  or  adonis  cupaniana,  given  in  doses  of 
■jij  to  -J  grain  several  times  daily,  is  employed  as  a  substitute  for  digitalis. 

Dr.  H.  J.  Hare  has  examined  its  action  on  healthy  animals.  It  first 
slows,  then  accelerates  and  arrests  the  heart  of  frogs  in  diastole,  height- 
ening tension  as  the  mesenteric  arteries  enlarge.  On  warm-blooded 
animals  it  acts  similarly,  increasing  the  force  of  the  heart's  contraction 
and  heightening  arterial  tension.  At  first  it  slows  and  then  accelerates 
the  heart,  arresting  it  in  diastole.  With  small  doses  no  primary  slow- 
ing occurs.  The  initial  slowing  is  due  to  stimulation  of  the  vagus,  and 
the  subsequent  acceleration  follows  paralysis  of  the  vagus.  It  heightens 
tension  partly  by  increasing  the  heart's  action,  but  chiefly  by  its  stimu- 
lating eifect  on  the  vaso-motor  centre.  It  is  evident,  therefore,  that  as 
respects  its  influence  on  the  vagus  adonidin  is  like  digitalis.  Dr.  Hare 
does  not  mention  its  direct  action  on  the  heart  muscle,  which  is  so  con- 
spicuous with  digitalis.  Moreover,  adonidin  differs  from  digitalis  by 
heightening  arterial  tension  through  its  effects  on  the  vaso-motor  centre. 
In  my  experiments  I  find  that  adonidin  affects  the  frog's  heart  in  all 
respects  like  digitalis. 

Mr.  Bradford,  in  his  experiments  on  cats,  dogs,  and  rabbits,  on  blood 
pressure  and  supply  of  blood  to  the  kidneys,  finds  adonidin  acts  very 


360  TOBACCO. 

similarly  to  digitalis;  but  it  differs  from  digitalis  in  not  increasing  the 
urine,  and  in  this  resj)ect  acts  like  sparteine. 

Notwithstanding  these  differences,  adonidin  seems  clinically  to  act 
just  like  digitalis,  and  to  be  indicated  in  identically  the  same  diseases. 
It  is  mainly  useful  in  mitral  disease,  slowing  and  strengthening  the  heart, 
heightening  arterial  tension,  removing  venous  distension,  and  increasing 
the  secretion  of  urine,  removing  by  this  means  dropsy. 

It  sometimes  causes  vomiting  and  diarrhoea,  with  intestinal  spasm. 

The  plant  is  caustic  and  vesicating,  and  the  crushed  plant  is  some- 
times used  as  a  domestic  remedy  to  blister. 


TOBACCO. 


A  POTJLTICE  of  tobacco  leaves  is  said  to  relieve  pain,  and  an  ointment, 
made  by  boiling  half  an  ounce  of  tobacco  in  eight  ounces  of  lard,  kept 
constantly  applied  to  the  breasts,  is  also  said  to  arrest  the  secretion  of 
milk.  In  this  respect  it  is  probably  inferior  to  belladonna.  ( Vide  Bel- 
ladonna,) 

As  several  deaths  have  occurred  through  the  application  of  tobacco 
to  the  abraded  skin,  it  must  be  used  externally  with  caution. 

Tobacco,  when  introduced  into  the  eye,  contracts  the  pupil,  also  when 
taken  by  the  stomach. 

Tobacco  produces  nausea  and  sickness,  accompanied  by  great  weak- 
ness and  faintness.  It  confuses  the  ideas,  dims  the  sight,  enfeebles  the 
pulse,  and  makes  the  skin  cold  and  clammy  with  profuse  sweating.  Owing 
to  its  prostrating  effects  it  removes  spasm.  Tobacco  in  the  form  of  clyster, 
or  administered  by  the  stomach,  has  been  employed  in  colic  of  the  intes- 
tines, and  in  strangulated  hernia;  but  in  spasmodic  diseases  chloroform 
has  quite  superseded  it.  Tobacco-smoking  excites  an  abundant  secretion 
of  saliva;  hence  some  persons  maintain  that  tobacco-smoking  aids  diges- 
tion. Smoking  acts  on  the  intestines  as  a  slight  purgative,  and  no  doubt 
a  pipe  or  cigar  smoked  after  breakfast  is  often  sufficient  to  insure  an  easy 
and  satisfactory  relief  of  the  bowels ;  and  is,  perhaps,  a  practice  not  with- 
out advantage  in  habitual  constipation. 

Smoking  in  excess  is,  no  doubt,  a  very  injurious  habit,  disordering 
digestion,  lessening  the  appetite,  inducing  restlessness  at  night,  with  dis- 
agreeable dreams,  and  weakening  both  mind  and  body.  Chronic  pharyn- 
gitis, the  mucous  membrane  looking  like  dirty-red  velvet,  with  constant 
hawking,  and  also  chronic  dyspepsia  may,  in  some  instances,  be  clearly 
traced  to  excessive  smoking.  Even  amaurosis  is  said  to  be  sometimes 
produced  by  excessive  smoking.  The  habitual  smoker  has  generally  a 
thickly-coated  tongue.  The  symptoms  produced  by  excessive  smoking 
soon  cease  when  the  habit  is  discontinued.  If  the  tobacco  is  of  good 
quality,  and  contains  but  little  nicotine,  the  evil  consequences  are  much 
less  marked.  In  the  cultivation  of  the  plant,  it  is  a  point  of  importance 
to  develop  the  aromatic  principles,  and  to  diminish  nicotine. 

Nicotine  causes  in  frogs  tetanus  and  general  paralysis.  In  warm- 
blooded animals  there  occur  twitchings  and  startings,  and  tetanoid  con- 
vulsions, excited  by  the  slightest  stimulus;  the  breathing  is  greatly 
hurried,  and  the  animal  becomes  very  weak,  or,  if  the  dose  is  large,  com- 


CONIUM.  361 

pletely  paralyzed.  It  excites  perspiration,  and  in  cats  free  salivation. 
It  contracts  the  pupil,  whether  administered  internally  or  applied  topic- 
ally. We  have  here  an  instance  of  a  solanaceous  plant  contracting 
the  pupil  and  increasing  most  of  the  secretions,  in  these  respects  acting 
in  exactly  the  op})osite  way  to  most  other  solanaceous  plants,  with  the 
exception  of  pituri,  to  which  tobacco  is  very  closely  allied. 

Nicotine  tetanizes  by  its  action  on  the  cord.  It  paralyzes  the  cord, 
motor  nerves  (Vulpian,  Rosenthal,  Krocker),  the  peripheral  nerve  end- 
ings being  first  affected;  it  also  paralyzes  the  muscles  (Rene).  The 
brain  is  unaffected. 

Nicotia  appears  to  tetanize  the  heart,  for  when  this  organ,  from  a 
mechanical  cause,  has  ceased  to  contract  after  death,  the  direct  applica- 
tion of  nicotia  excites  the  pulsations,  and  the  heart  soon  becomes  rigidly 
contracted — tetanized,  in  fact — and  then,  of  course,  the  beats  cease.  In 
birds  and  mammals  killed  by  chloroform,  when  the  ventricles  are  im- 
mobile and  dilated,  and  respond  most  imperfectly  to  stimuli,  the  appli- 
cation of  a  drop  of  nicotine  immediately  occasions  strong  contractions 
in  the  heart,  and  causes  the  organ  to  respond  energetically  to  mechanical 
and  galvanic  stimuli. 

The  experiments  of  Fraser  and  Brown  show  that  nicotia,  like  other 
tetanizing  substances,  as  strychnia,  brucia,  thebaia,  codeia,  and  morphia, 
loses  its  tetanizing  properties  when  converted  into  ethyl  or  methyl  com- 
pounds; but,  unlike  these,  the  methyl  and  ethyl  compounds  of  nicotine 
do  not  possess  any  paralyzing  action  on  motor  nerves.  This  difference 
inclines  these  observers  to  believe  tliat  the  convulsions  of  nicotia  are  not 
produced  in  the  same  way  as  those  arising  from  strychnia,  brucia, 
thebaia,  etc. 

Nicotia  has  been  highly  praised  in  tetanus,  and  many  recorded  cases 
appear  to  show  its  usefulness  in  this  fatal  disease.  It  must  be  admin- 
istered either  by  the  rectum,  or  hypodermically;  when  put  into  the 
mouth,  it  very  generally  excites  a  severe  paroxysm,  which  may  destroy 
life,  by  firmly  fixing  the  muscles  of  the  chest  till  asphyxia  is  produced. 

Tobacco-smoking  commonly  affords  some  relief  in  spasmodic  asthma; 
but,  like  all  other  asthmatic  remedies,  it  succeeds  much  better  in  some 
instances  than  in  others. 

Whether  the  active  principle  of  tobacco  is  destroyed  in  the  system, 
or  is  eliminated  with  any  secretion,  is,  at  present,  unknown. 

Nicotine  is  supposed  to  be  diuretic,  but  we  are  not  told  under  what 
circumstances. 


CONIUM. 


We  are  chiefly  indebted  to  Christison,  Schroff,  Kolliker,  and  Gutt- 
mann,  for  our  knowledge  of  the  action  of  this  medicine.  Paul  Gutt- 
mann,  who  made  some  excellent  investigations  on  the  action  of  this 
alkaloid,  says  it  is  one  of  the  most  active  and  powerful  poisons,  being, 
in  this  respect,  scarcely  second  to  prussic  acid;  yet  some  vegetable- 
feeders,  as  goats,  sheep,  and  horses,  are  said  to  eat  hemlock  with  im- 
punity. 

Gonium  contains  two  alkaloids,  coniineand  methyl  coniine.  Conium 
exerts  no  influence  on  the  unbroken  skin,  even  when  a^jplied  in  large 


362  coNiuM. 

quantity;  but  strong  preparations  applied  to  wounds  excite  inflamma- 
tion, with  its  usual  accompaniments  of  heat  and  pain. 

The  pounded  leaves,  or  the  expressed  juice,  or  other  preparation  of 
the  drug,  smeared  over  a  poultice,  will  ease  the  pain  of  ulcers,  both 
simple  and  malignant,  and,  at  the  same  time,  improve  the  character  of 
the  sore.  The  pain-easing  property  of  hemlock  rests  on  the  evidence  of 
highly  competent  observers,  and  cannot  be  gainsaid ;  yet  it  is  now  rarely 
employed  for  this  purpose,  although  formerly  it  was  in  constant  use  as 
a  soothing  application  to  broken  cancers  and  malignant  sores. 

The  alkaloid,  coniine,  whether  directly  applied  to  the  eye  or  swallowed, 
eauses  dilatation  of  the  pupils,  sometimes  with  subsequent  contraction. 
According  to  Harley,  the  dilatation  is  never  very  great. 

The  smell  of  conium  has  been  compared  to  the  urine  of  cats  and 
mice.  It  has  a  burning,  acrid  taste,  provoking  an  increased  secretion  of 
saliva.  A  drachm  of  inhalatio  conise  in  boiling  water,  used  twice  or 
thrice  daily,  is  extremely  useful  in  irritable  cough  of  bronchitis  and 
fibroid  phthisis. 

Hemlock  has  scarcely  any  influence  on  the  stomach  and  intestines. 
It  may  produce  nausea,  vomiting,  and  diarrhoea;  but  such  occurrences 
are  not  common.  Walshe  has  seen  it  relieve  the  pain  of  cancer  of  the 
stomach. 

That  conia  enters  the  blood  is  proved  by  the  symptoms  arising  when 
it  is  swallowed;  but  the  physical  or  chemical  changes,  if  any,  it  under- 
goes in  the  blood  are  at  present  unknown.  Added  to  blood  after  its 
removal  from  the  body,  it  produces  in  it  no  perceptible  alteration. 

The  deficient  coagulability  and  dark  color  of  the  blood,  after  death 
from  this  drug,  noticed  by  some,  according  to  others  are  often  absent; 
and,  when  present,  are  due  probably  to  the  fatal  asphyxia. 

The  effects  of  conium  on  man  and  animals  is  very  similar.  The  best 
account  of  the  symptoms  occurring  in  a  human  being,  from  a  poisonous 
quantity  of  the  plant,  is  given  by  Dr.  H.  Bennett,  who  has  recorded  the 
case  of  a  man  who  ate  hemlock  in  mistake  for  salad.  Weakness  of  his 
legs,  so  that  his  gait  was  faltering,  was  first  noticed;  as  the  weakness  in- 
creased he  staggered  as  if  drunk,  and,  at  the  same  time,  his  arms  began 
to  be  similarly  affected.  Perfect  loss  of  all  voluntary  movement  followed, 
and  he  was  unable  even  to  swallow.  Lastly,  the  muscles  of  respiration 
were  slowly  paralyzed,  and  he  died  of  asphyxia.  Up  to  his  death  his 
intelligence  was  apparently  unaft'ected,  but  his  sight  was  destroyed. 
Slight  movements  in  the  muscles  of  the  left  leg  took  place. 

The  same,  or  nearly  the  same,  sequence  of  events  happens  in  animals 
poisoned  by  hemlock.  With  rabbits,  early  and  severe  convulsions  occur, 
but  in  frogs  these  are  absent.  In  all  the  experiments  and  observations 
of  Guttmann,  gradual  paralysis  of  the  voluntary  muscles,  and  then  of 
the  respiratory  muscles,  took  place.  The  paralysis  began  first  in  the 
hind  extremities,  next  affected  the  anterior,  soon  afterwards  the  muscles 
of  the  trunk,  and  lastly  those  of  resjnration. 

Coniiue  affects  chiefly  the  motor  nerves,  paralyzing  first  the  end  jilates. 
It  also  paralyzes  the  terminations  of  the  vagus.  The  spinal  cord  is  but 
little  affected.  Some  experimenters  assert  that  it  affects  the  cord  to  a 
slight  extent,  like  strychnia,  and  depresses  the  reflex  function.  The 
sensory  nerves  and  muscles  are  unaffected. 

Conia  appears  also  to  affect  some  parts  of  the  vaso-motor  nerves; 
thus  the  arteries  of  the  frog's  foot  fail  to  contract  on  irritation  when 


CONIUM.  363 

the  animal  is  poisoned  by  hemlock,  but  tlie  motor  nerves  of  some  other 
involuntary  muscles  are  uninfluenced  by  conia,  as  the  peristaltic  contrac- 
tion of  the  intestines  of  the  rabbits  killed  by  the  alkaloid  continued 
active  after  death. 

Its  influence  on  the  brain  Avill  next  be  considered.  No  doubt  both 
man  and  animals  remain  conscious  of  pain  so  long  as  they  are  capable  of 
giving  any  signs  of  it;  that  is  before  the  muscles  of  expression  become 
IDaralyzed.  But  consciousness  is  possible,  though  at  the  same  time  the 
brain  may,  in  some  way,  be  afl'ected.  Schroff  states  that  the  poison,  soon 
after  it  is  taken,  is  followed  by  a  sensation  of  heaviness  in  the  head,  with 
giddiness,  inability  to  think,  great  impairment  to  common  sensibility, 
blunted  taste,  dimmed  sight,  dilated  pupils,  and  a  sensation  as  of  insects 
crawling  on  the  skin. 

The  mind  .is  evidently  in  some  degree  weakened,  and  many  of  the 
special  senses  suffer.  In  Dr.  Bennett's  case  there  was  total  blindness, 
but  the  hearing  was  little,  if  at  all,  dulled.  Some  observers  assert  that 
the  mind  remains  quite  uninfluenced  by  hemlock. 

In  poisoning  by  hemlock,  as  I  have  said,  the  pupils  dilate;  at  the 
same  time  there  is  drooj^ing  of  the  upper  eyelid,  due,  of  course,  to 
jDaralysis  of  the  third  nerve,  which  leads  JJr.  II.  Wood  to  conclude  that 
hemlock  affects  the  pujDil  by  paralyzing  the  third  nerve,  not  by  stimu- 
lating the  sympathetic. 

At  an  early  part  of  this  section  it  was  stated  that  convulsions  resulted 
from  poisoning  by  conium.  Convulsions  occur  in  some  animals,  not 
in  others.  Kabbits  appear  to  sulfer  from  convulsions,  but  frogs  die 
unconvulsed.  These  spasms,  Kolliker  has  suggested,  may  be  due  to 
asphyxia  from  paralysis  of  the  muscles  of  respiration.  This  explanation, 
however,  appears  to  be  insufficient,  as  convulsions  are  often  among  the 
earliest  symptoms,  before  any  asphyxia  has  resulted;  nay,  if  a  tube  is 
introduced  into  the  trachea  and  artificial  respiration  is  performed,  they 
still  occur.  In  man  convulsions  are  certainly  sometimes  absent,  ;fnd  in 
the  case  recorded  by  Bennett,  only  slight  movements  in  the  left  leg 
were  witnessed. 

Drs.  Crum  Brown  and  Fraser  have  shown  that  specimens  of  conia 
are  not  of  identical  composition;  for,  while  each  specimen  produced  the 
same  symptoms,  these  they  find  were  not  always  produced  in  the  same 
way.  In  other  words,  some  specimens  affect  chiefly  the  motor  nerves, 
while  others  act  on  both  motor  nerves  and  cord.  Their  observations  on 
hydrochlorate  of  conium,  methyl-conia,  and  iodide  of  dimethyl-conium 
in  a  great  measure  explain  these  differences.  They  conclude  that  conia 
"2)roduces  paralysis  solely  by  influencing  the  motor  nerves."  and  that 
hydrochlorate  of  methyl-conia  acts  "  on  the  motor  nerve  and  spinal  cord. 
With  large  doses  the  former  action  is  completed  before  the  latter."  They 
conclude  that  commercial  specimens  of  conia  consist  of  mixtures  in  vari- 
able proportions  of  conia  and  methyl-couia.  Sometimes  meth3'l-conia  is 
present  in  small,  at  other  times  in  large  quantities ;  and  that  this  variety 
of  composition  explains  the  varied  physiological  effects  of  different 
specimens  of  conia. 

Their  observations  on  iodide  of  dimethyl-conium  "  show  that  the 
paralysis  produced  by  dimethyl-conium  is  dependent  on  an  action  on  the 
motor  nerves  primarily  restricted  to  the  iDcripheral  terminations." 

Concerning  the  action  of  this  poison  on  the  heart,  very  conflicting 
statements  have  been  made.     Some  authorities  state  that  it  reduces  the 


364  coNiUM. 

frequency  of  the  pulse,  especially  when  the  heart  beats  too  quickly  from 
disease,  as  from  fever,  etc.  Even  a  small  dose  iinder  such  conditions, 
they  say,  suffices  to  produce  a  decided  effect  on  the  pulse,  while  in  health 
the  same  quantity  exerts  no  influence.  Such  are  the  conclusions  of 
Wertheim. 

Kolliker,  Guttmann,  and  J.  Harley  conclude  that  conium  does  not 
affect  the  heart.  Harley,  who  gave  the  medicine  in  sufficient  quantities 
to  produce  partial  paralysis,  says,  "  excepting  as  a  transient  emotional 
effect  in  nervous  individuals  upon  the  sudden  accession  of  the  symp- 
toms after  a  first  dose  of  hemlock  the  heart  and  blood-vessels  are  abso- 
lutely unaffected  by  its  operation.  I  have  carefully  determined  this  in 
persons  of  all  ages — in  the  weakly  infant  not  three  months  old,  in  the 
strong,  in  the  debilitated,  and  in  those  who  have  intermittent  action  of 
the  heart." 

In  exj^eriments  with  warm-blooded  animals  poisoned  by  hemlock  the 
heart,  it  is  true,  soon  ceases  to  beat;  but  this  can  be  for  a  long  time 
retarded  if  artificial  respiration  is  performed,  and  in  the  case  of  the  frog 
the  poison  appears  to  leave  the  heart  unaffected. 

In  doses  sufficient  to  produce  physiological  effects,  conium,  Harley 
says,  may  be  taken  for  months  without  affecting  nutrition,  and  my  ex- 
jDerience  quite  confirms  this  statement. 

It  is  supposed  to  be  useful  in  whooping  and  other  coughs.  The  suc- 
cus  conii  in  one-  to  fonr-drachm  doses,  or  even  more,  has  been  recom- 
mended lately  by  J.  Harley  in 'chorea;  and  these  large  doses  certainly 
control  the  movements  temporarily,  and  impart  steadiness  to  the  patient; 
but  the  improvement  wears  off  if  the  medicine  is  not  soon  repeated. 
Some  cases,  no  doubt,  are  cured;  but  in  my  exjaerience  this  treatment 
in  most  instances  only  palliates,  and,  on  discontinuing  the  drug,  the 
symptoms  return  with  customary  severity.  In  order  to  maintain  the 
effects  of  conium  on  the  choreic  movements,  the  dose  must  be  quickly 
increased,  for  patients  speedily  become  tolerant  of  the  drug,  and  after  a 
short  time  will  bear  enormous  doses  without  the  induction  of  any  ph3'si- 
ological  effect.  Thus  on  one  occasion  I  gradually  increased  the  dose, 
till  the  patient — a  child — took,  except  when  asleep,  seven  drachms  of 
succus  conii  hourly. 

We  have  the  high  authority  of  Dr.  Neligan  in  favor  of  hemlock  in 
various  painful  affections,  as  cancer,  rheumatism,  and  neuralgia.  It  has 
not  yet  been  shown  in  any  well-authenticated  case  that  conium  produces 
either  sleep,  coma,  or  delirum. 

Considering  the  physiological  action  of  conia,  it  would  appear  that 
it  is  not  indicated  in  convulsive  diseases  dependent  on  affections  of  the 
cord,  as  tetanus  and  strychnia  poisoning;  for  the  effects  of  this  drug, 
and  the  symptoms  of  these  diseases  are  not  antagonistic.  Guttmann 
j)ut  to  the  test  of  direct  experiment  the  power  of  conia  to  arrest  or  clieck 
in  any  degree  the  tetanus  from  strychnia.  He  strychnized  frogs,  and 
then  gave  them  conia,  but  even  when  administered  in  doses  sufficient 
to  completely  paralyze  the  animals,  this  drug  failed  to  check  in  any 
degree  the  tetanic  spasms  produced  by  the  strychnia. 

Professor  Christopher  Johnson,  of  Maryland,  however,  reports  cases 
of  recovery  from  severe  traumatic  tetanus  under  the  use  of  conia.  In 
one  case  he  injected  hypodermically,  every  two  hours,  fifteen  minims  of 
a  solution  composed  of  two  minims  of  conia,  one  minim  of  dilute  sul- 
phuric acid  to  one  drachm  of  water.     In  the  second  case  he  commenced 


CALABAR    BEAN.  305 

with  twenty  minims  of  the  same  sohition  every  three  hours;  he  then 
increased  the  conia  to  one-third,  then  to  two-thirds,  of  a  drop,  and 
ultimately  to  rather  more  than  a  drop  every  hour,  when  the  symptoms 
abated.  Afterwards  he  used  two  minims  of  conia  hourly,  but  owing  to 
the  weakness  of  the  pulse,  he  returned  to  one  minim  every  two  hours, 
but  the  spasms  returning,  he  again  used  two  minims  every  hour,  and 
immediately  the  spasms  diminished.  But  these  cases,  unfortunately, 
are  much  less  satisfactory  than  they  might  have  been.  In  the  first  case, 
the  cicatrices  of  the  wound  were  removed  by  a  hot  iron,  and  in  the 
second  bromide  of  potassium  and  morphia  were  administered.  But  Dr. 
Johnson  says  that  the  spasms  were  considerably  reduced  after  each  conia 
injection.    • 

It  will  be  obvious  how  very  similar  the  action  of  conia  is  to  that  of 
curare.  One  difference  there  is  between  these  substances  which  has  not 
been  noted.  Curare,  when  swallowed,  is  not  poisonous,  but  is  strongly 
toxic  when  injected  under  the  skin;  conia,  in  either  Avay,  is  equally 
poisonous. 

Claude  Bernard  believes  that  the  innocuousness  of  curare  admin- 
istered by  the  stomach  is  due  to  its  slow  absorption,  as  contrasted  with 
its  much  more  rapid  elimination  by  the  kidneys,  so  that  a  very  minute 
quantity  is  retained  in  the  blood. 

The  most  reliable  preparation  is  the  succus  conii. 


CALABAR  BEAN. 


Poisoning  by  calabar  bean  induces  the  following  symptoms : — Weak- 
ness progressing  to  complete  paralysis;  arrest  of  respiration;  quivering 
or  fibrillary  contraction  of  the  muscles;  increased  secretion  of  saliva; 
relaxed  bowels  with  '  griping  pains ;  contracted  pupils ;  heightened 
arterial  tension;  sometimes  strychnia-like  tetanus;  whilst  the  mind 
remains  unaffected. 

It  apparently  leaves  the  brain  unaffected,  but  paralyzes  the  medulla 
and  spinal  cord,  the  posterior  columns  before  the  anterior;  thus  it  causes 
weakness  and  paralysis  and  arrest  of  respiration.  The  motor  nerves  are 
very  little  affected,  and  the  sensory  only  when  a  strong  solution  is 
applied  topically  to  the  nerve. 

The  fibrillary  contractions  are  due  to  the  action  of  the  poison  either 
on  the  muscle  or  on  the  motor  nerve,  for  they  occur  when  the  limb  is 
separated  from  the  nervous  centres;  and  since  the  contractions  are  con- 
trollable by  curare  they  probably  depend  on  some  change  in  the  termi- 
nations of  the  motor  nerves. 

Physostigma  increases  most  secretions,  as  the  salivary,  lachrymal, 
cutaneous,  and  the  secretion  from  mucous  membranes,  affecting  prob- 
ably the  glandular  secreting  cells.  It  also  stimulates  voluntary  and  in- 
voluntary muscular  fibres  or  their  peripheral  ganglia;  hence  it  gives  rise 
to  colicky  pains  and  a  relaxed  condition  of  the  bowels.  It  also  contracts 
the  bladder,  uterus,  and  spleen. 

It  contracts  the  pupil,  heightens  intra-ocular  pressure,  and  produces 
spasm  of  the  muscle  of  accommodation,  probably  by  stimulating  the 
terminations  of  the  third  nerve,  and  not  by  paralyzing  the  sympathetic. 
It  is  largely  used  in  eye  diseases. 


366 


CALABAK  BEAN. 


Physostigma  afEects  the  heart  according  to  the  dose;  a  small  quantity 
is  said  to  strengthen  and  lessen  the  frequency  of  the  contractions;  a 
large  quantity  kills  by  arresting  the  heart  in  diastole.  It  first  accel- 
erates and  then  retards  respiration  by  stimulating  the  vagi  termi- 
nations. 

The  increased  arterial  tension  is  largely  due  tothe  strengthening 
influence  of  the  drug  on  the  heart,  though  probably  in  some  measure  to 
vaso-motor  stimulation,  or  direct  action  on  the  muscular  coat. 

The  strychnia-like  convulsions  are  probably  due  to  calabarine,  which 
is  reported"to  act  like  strychnia,  whilst  all  the  other  symptoms  are  due 
to  eserine. 

We  now  come  to  the  therapeutical  application  of  this  remedy.  It 
was  some  time  ago  suggested  that  the  calabar  bean  might  prove  of  much 
service  in  tetanus  and  chorea,  and  Dr.  Fraser  has  written  an  interesting 
paper  on  this  subject.  Finding  that  the  effect  of  strychnia  on  the  frog 
can  be  arrested,  he  believes  that  the  bean  may  be  used  with  the  greatest 
benefit  in  tetanus.  Dr.  Fraser  very  naturally  insists  on  the  importance 
of  employing  the  drug  at  the  very  beginning  of  the  attack.  It  may  be 
administered  by  mouth,  anus,  or  subcutaneously.  When  the  convulsions 
are  severe,  and  when  the  slightest  movement  excites  them,  it  is  obvious 
that,  till  the  severity  of  the  paroxysms  is  subdued,  only  the  subcutaneous 
method  can  be  used.  Yet,  whilst  the  patient  can  still  swallow,  my  ex- 
perience leads  me  to  prefer  giving  the  drug  by  the  mouth ;  for  the  drug 
to  be  of  any  use  it  must  be  giv^n  in  quantity  sufficient  to  produce  paral- 
ysis, and  must  be  pushed,  indeed,  to  such  an  extent,  that  but  a  little 
more  would  permanently  arrest  breathing.  The  drug,  therefore,  must 
be  given  with  great  care  and  watchfulness,  and  to  get  the  necessary 
effects  without  inducing  serious  symptoms  it  is  better  to  give  small  and 
increasing  quantities  every  hour,  or'oftener,  for  then,  should  serious 
l^aralytic  symptoms  arise,  the  drug  can  be  stopped.  Moreover,  it  is  im- 
possible to  tell  the  dose  adequate  to  subdue  the  paroxysms,  and  produce 
paralysis,  some  persons  requiring  a  much  larger  quantity  than  others. 
Hence  it  is  evident  that  it  is  more  convenient  to  give  the  liquid  extract 
by  the  mouth  than  subcutaneously.  I  have  already,  in  part,  spoken  of 
the  dose.  It  is  generally,  nay,  probably  always,  necessary  to  produce  a 
certain  degree  of  paralysis,  amounting  to  heaviness  of  the  limbs.  Some- 
times the  dose  of  the  spirituous  extract  must  be  very  large;  thus,  Dr. 
Eben  Watson,  who  failed  to  obtain  good  effects  from  hypodermic  injec- 
tion, prefers  to  administer  the  drug  by  the  mouth,  or  rectum,  and  insists 
on  the  necessity  of  giving  enough  extract  to  produce  relaxation  of  the 
spasms.  He  has  given  it  to  the  extent  of  seventy-two  grains  in  twenty- 
four  hours. 

In  a  successful  case  under  my  care,  reported  in  the  Pracfiiioner,  the 
patient,  for  a  day  and  a  half,  took  2f  grains  of  the  watery  extract  hourly, 
and  for  a  short  time  4  grains  hourly.  It  is,  of  course,  too  much  to  ex- 
pect that  Calabar  bean  will  cure  every  case  of  tetanus,  but  I  feel  con- 
vinced that,  were  the  treatment  begun  at  the  outset  of  the  attack,  and 
were  the  drug  pushed  sufficiently,  the  results  would  be  more  successful 
than  those  at  present  attained. 

Dr.  Fraser  next  makes  a  few  remarks  on  the  influence  of  this  remedy 
over  chorea,  but  at  present  there  appears  to  be  little  evidence  on  this 
subject.  "  The  treatment  of  this  disease,"  he  says,  "  will  rarely  require  to 
be  so  active  or  energetic  as  that  recommended  for  tetanus.     Physostigma 


CALABAR   BEAN.  367 

should  be  administered  either  in  the  form  of  powder  or  of  tincture.  From 
three  to  six  grains  of  powder,  three  or  four  times  daily,  may  be  given  to 
children,  and  from  ten  to  twenty  grains,  as  frequently,  to  adults." 

Dr.  Crichton  Browne  finds  Calabar  bean  markedly  useful  in  general 
paralysis  of  the  insane;  indeed,  he  states  that  he  has  even  cured  some  of 
his  patients  of  this  severe  disease.  I  have  known  it  arrest  the  progress 
of  general  paralysis,  and  even  slightly  improve  the  mental  and  physical 
condition.  I  have  seen  it  not  only  arrest  progressive  muscular  wasting, 
.uncomplicated  with  much  mental  disorder,  but  also  eifect  considerable 
improvement  in  the  muscular  power.  Moreover,  it  has  appeared  to  me  to 
be  serviceable  in  some  cases  of  long-standing  hemiplegia.  I  have  given 
the  extract  of  physostigma  in  one-thirtieth  of  a  grain  doses  every  two 
hours. 

In  conjunction  with  Dr.  Murrell,  I  have  made  observations  on  the  in- 
fluence of  Calabar  bean  on  certain  nervous  affections,  giving  one-tenth  of 
a  grain  of  the  extract  every  three  hours,  and  in  some  instances  we  have 
continued  this  treatment  more  than  a  year.  We  gave  it  in  five  cases  of 
paraplegia,  due  probably  to  myelitis.  In  one  case  no  improvement  ensued; 
and  but  slight  amendment  in  another;  but  even  when  the  drug  failed  to 
produce  any  improvement  it  yet  seemed  to  us  to  arrest  the  disease.  In 
old-standing  cases  we  could  hardly  hope  for  any  amendment,  where  the 
lower  part  of  the  cord  had  become  disorganized;  but  we  might  fairly  hope 
to  control  the  march  of  the  disease  in  the  less  affected  parts.  In  two 
cases  very  marked  improvement  occurred,  an  improvement  so  decided  as 
fairly  to  astonish  us,  but  in  both  relapse  took  place,  and  the  patients 
became  as  bad  almost  as  before  undergoing  treatment. 

In  the  fifth  case  the  treatment  effected  a  considerable  and  permanent 
improvement,  so  that  the  patient,  who  was  unable  to  move  his  legs  even 
in  a  slight  degree,  was  enabled,  before  his  discharge,  to  walk  about  the 
ward  without  his  stick.  These  cases,  it  will  be  said,  do  not  tell  conclu- 
sively in  favor  of  the  efficacy  of  physostigma  in  paraplegia;  we  were  both, 
however,  struck  by  the  evident  temporary  improvement  in  some  of  the 
cases,  and  the  decided  and  permanent  amendment  of  one  patient,  which 
we  could  not  help  attributing  to  the  drug,  and  we  feel  sure  that  this 
subject  is  well  worth  further  investigation.  We  gave  the  drug  in  the 
same  doses  to  two  cases  of  locomotor  ataxy,  in  one  case  for  a  year,  in  the 
other  for  three  months:  both  cases  improved,  and  one,  a  very  bad  case, 
considerably.  We  gave  it  also  in  ,a  recent  case  of  writer's  cramp,  and  in 
two  months  the  patient  recovered. 

Dr.  Bartholow  recom. mends  Calabar  bean  in  the  flatulence  of  the 
climacteric  period. 

Between  Clalabar  bean  on  the  one  hand,  and  chloral,  atropia,  and 
strychnia  respectively,  there  is  a  well-marked  antagonism.  Here  we  shall 
have  occasion  to  speak  only  of  the  antagonism  between  physostigma  and 
chloral,  referring  the  reader  for  an  account  of  the  other  antagonisms  to  the 
chapter  on  belladonna,  and  that  on  strychnia.  The  Committee  of  the 
British  Medical  Association,  in  their  recently  published  investigations  con- 
cerning the  antagonism  between  drugs,  concluded  that  the  antagonism 
between  physostigma  and  chloral  is  greater  than  that  between  physostigma 
and  atropia.  They  point  out  that  the  antidotal  properties  of  a  drug  are, 
of  course,  modified  by  its  more  or  less  rapid  action  on  the  system.  Serious 
and  even  fatal  symptoms  ensue  from  Calabar  bean  much  more  speedily 
than  from  chloral;  therefore,  to  obtain  the  antagonistic  effect  of  chloral. 


368  MUSCAREN". 

it  must  be  given  either  "before,  or  immediately  after  the  ingestion  of  Cala- 
bar bean.  The  antagonism  is  not  complete,  for,  in  spite  of  an  antidotal 
dose  of  chloral,  physostigma,  although  it  averts  convulsions,  still  produces 
muscular  twitchings,  tremors,  salivation,  and  contracted  pupil;  more- 
over, a  quantity  of  Calabar  bean  beyond  a  minimum  fatal  dose  will  kill, 
notwithstanding  chloral. 


MUSCARIN. 


MuscABiisr,  the  active  principle  of  poisonous  fungi,  was  first  extracted 
from  the  Amanita  muscaria,  and  physiologically  tested  by  Schmiedeberg. 
He  has  since  discovered  a  second  alkaloid,  identical  with  Jaborin,  an 
alkaloid  of  pilocarpine,  and  this  alkaloid  is  antagonistic  tomuscarin,  as 
jaborin  is  antagonistic  to  pilocarpine,  llis  conclusions  regarding  muscarin 
have  been  confirmed  and  ou^-  information  extended  by  the  researches  of 
Koppe,  Prevost,  Alizon,  Lauder  Brunton,  and  Schiff.  Great  interest 
atbiches  to  muscarin  on  account  of  the  close  similarity  of  its  action  to 
pilocarpine  and  its  almost  complete  antagonism  to  atropia.  It  excites 
copious  perspiration  and  salivation,  a  flow  of  tears,  and  it  increases  the 
intestinal  mucus  and  the  biliary  and  pancreatic  secretions.  Muscarin 
affects  especially  the  heart  and  intestinal  canal.  According  to  Lauder 
Brunton  it  produces  "  uneasiness  in  the  stomach,  vomiting,  purging,  a 
feeling  of  constriction  in  the  neck,  want  of  breath,  giddiness,  fainting, 
prostration,  and  stupor."  The  stools  sometimes  contain  mucus  or  even 
blood.  Topically  applied,  the  merest  trace  at  once  arrests  a  frog's  heart; 
it  slows  the  heart  of  mammals,  reducing  the  beats  from  120  to  60,  40,  or 
even  9  beats  per  minute,  and  sometimes  it  causes  intermittency.  ^I. 
Alizon  maintains  that  it  first  quickens  the  heart.  It  arrests  the  heart  in 
diastole;  according  to  Prevost,  by  exciting  the  intracardiac  nerve-centres. 
It  diminishes  blood-pressure  partly  by  its  action  on  the  heart,  but  partly 
by  dilating  the  blood-vessels.  Respiration  is  depressed  in  proportion  to  the 
depression  of  the  pulse.  It  causes  strong  contraction  of  the  intestines  and 
bladder;  it  lessens  urinary  secretion,  even  to  the  point  of  suppression; 
it  contracts  the  pupils. 

In  all  these  particulars  atropia  promptly  antagonizes  muscarin.  When 
a  frog's  heart  is  arrested  by  the  topical  action  of  a  minute  quantity  of 
muscarin,  the  .application  of  a  little  atropia  will  immediately  restore  the 
pulsations. 

Lauder  Brunton  has  shown  tliat  muscarin  has  a  singular  effect  on  the 
IHilmonary  vessels.  Schmiedeberg  had  noticed  that  muscarin  produces 
intense  dyspnoea — a  condition  in  which  the  arteries  contain  very  little 
blood,  scarcely  bleeding  when  cut  across.  Brunton's  experiment  on  a 
narcotized  rabbit  shows  that  this  dyspucea  is  due  to  the  muscarin  causing 
strong  contraction  of  the  pulmonary  blood-vessels,  so  strong  that  the  lungs 
become  blanched,  and,  owing  to  the  contracted  state  of  the  pulmonary 
blood-vessels,  the  right  side  of  the  heart  becomes  greatly  distended.  A 
small  quantity  of  atropia  injected  into  the  jugular  vein  at  once  removed 
this  spasm  of  the  pulmonar\^  vessels,  and  unloaded  the  gorged  right  heart. 
Muscarin,  like  pilocarpine  (jaborandi),  is  supposed  to  arrest  the  heart 
by  stimulating  the  intracardiac  inhibitory  apparatus. 

Stimulation  of  the  vagus  inhibits  the  heart's  action.     Thus  the  appli- 


I 


MUSCAKiisr.  369 

cation  of  a  weak  electric  current  prolongs  diastole  and  so  slows  tlic  heart, 
whilst  a  strong:  current  completely  arrests  the  heart.  After  poisoning  by 
curare,  stimulation  of  the  vagus  no  longer  affects  the  heart,  but  on  apply- 
ing the  electrodes  tq  the  sinus  venosus  the  heart's  action  is  immediately 
inhibited.  It  is  therefore  concluded  that  curare  paralyzes  the  vagus  but 
leaves  the  intracardiac  inhibitory  apparatus  unaffected.  After  poisoning 
by  atropia  neither  stimulation  of  the  vagus  nor  of  the  sinus  affects  the 
heart,  therefore  it  is  concluded  that  atropia  poisons  both  the  vagus  and 
the  intracardiac  inhibitory  apparatus.  The  local  application  of  either 
muscarin  or  pilocarpine  quickly  arrests  the  beat  in  diastole,  "  like  a  heart 
inhibited  by  profound  and  lasting  vagus  stimulation.  This  effect  is  not 
hindered  by  curare.  The  application  of  a  small  dose  of  atropia  at  once 
restores  the  beat.  These  facts  are  interpreted  as  meaning  that  muscarin 
(or  jaborandi)  stimulates  or  excites  the  intracardiac  inhibitory  apparatus 
which  atropia  paralyzes."     (Foster's  Physiolofiy.) 

Eecent  investigations,  made  by  Mr.  Morshead  and  myself,  show  that 
pilocarpine  and  muscarin  paralyze  the  cardiac  excito-motory  apparatus  and 
the  cardiac  muscular  substance.  Atropia,  therefore,  antagonizes  the 
action  of  muscarin  and  pilocarpine  on  these  structures.  As  atropia  itself 
paralyzes  the  excito-motory  apparatus  a^iid  muscular  substance  we  have  an 
instance  of  a  substance  which  paralyzes  a  structure  antagonizing  the  action 
of  another  substance  which  paralyzes  the  same  structure. 

Pilocarpine  and  muscarin  paralyze  the  excito-motory  apparatus,  and 
yet  pilocarpine  removes  the  paralyzing  action  of  muscarin  on  these  struc- 
tures, and  in  this  respect  is  nearly  as  powerful  as  atropia.  Here  we  have 
another  instance  of  a  jmralyzer  of  the  excito-motory  apparatus  and  cardiac 
muscle  antagonizing  the  action  of  a  substance  which  also  paralyzes  the 
excito-motory  apparatus  and  cardiac  muscle.  We  have  suggested 
that  this  antagoiiism  is  due  to  chemical  displacement;  that  atropia  and 
pilocarpine,  whilst  paralyzing  the  cardiac  structures  to  a  much  less  degree 
than  muscarin,  have  a  stronger  affinity  for  the  cardiac  nervous  structure 
and  nmscular  substance  than  muscarin;  hence  atropia  and  pilocarpine 
displace  muscarin  and  substitute  their  weaker  action  for  the  more  power- 
ful action  of  muscarin. 

Schiff  believes  that  poisonous  mushrooms  produce  other  symptoms 
than  can  be  accounted  for  by  the  action  of  muscarin,  as  restlessness,  con- 
vulsions, and  dilatation  and  contraction  of  the  pupils;  and  he  is  led  to 
believe  that  poisonous  mushrooms  contain  two  active  ingredients — one 
having  an  opposite,  the  other  a  similar,  action  to  that  of  atropia. 

In  conjunction  Avith  Mr.  E,  A.  Morshead  I  have  made  some  investiga- 
tions regarding  the  action  of  muscarin  on  the  human  body. 

Our  observations  were  undertaken  to  endeavor  to  ascertain  whether  the 
action  of  muscarin  on  man  is  the  same  as  on  animals.  The  muscarin  we 
employed  was  synthetically  prepared  by  Merck,  of  Darmstadt.  In  the 
following  experiments  we  administered  the  drug  hypodermically.  We 
have  made  thirteen  experiments  on  four  men,  seven,  three,  two,  and  one 
respectively.  These  men,  it  is  well  to  state,  were  not  in  good  health; 
three  were  in  a  delicate  anasmic  state,  the  other  had  slight  fever  from 
some  obscure  cause,  though  his  pulse  was  not  quickened. 

A  large  number  of  preliminary  observations  were  made  to  ascertain 
the  minimum  dose  adequate  to  produce  symptoms.  This  we  found  to  be 
a  third  of  a  grain  given  hypodermicall}^ 

We  find  that  the  action  of  muscarin  on  man  is  identical  with  that  on 
24 


370  JIUSCARIN". 

animals.  It  contracts  tlio  pupil,  excites  profuse  perspiration,  free  saliva- 
tion, running  at  the  eyes  and  nose;  it  ^^^^I'gcs,  sometimes  excites  nausea 
and  vomiting,  and  a  strong  desire  to  pass  urine. 

We  shall  now  speak  more  in  detail  of  these  different  effects. 

Pers])inifion. — Sweating  occurred  in  eleven  of  the  thirteen  experi- 
ments. Half  a  grain  always  made  it  free,  Avhilst  larger  doses,  as  three- 
quarters  of  a  grain  or  a  grain,  rendered  it  very  abundant;  quite  as  free, 
indeed,  as  the  perspiration  excited  by  a  third  to  half  a  grain  of  jDilocarpine. 
After  the  larger  doses  the  perspiration  stood  in  large  drops  on  the  face, 
the  night-dress  became  soaked,  and  the  skin  felt  sodden.  In  one  man, 
though  we  gave  one-third  of  a  grain  and  one  grain  respectively  in  two 
experiments,  we  produced  no  sweating,  but  free  salivation,  amounting  to 
four  ounces.  Perspiration  began  in  from  three  to  fifteen  minutes,  oc- 
curring earliest  after  the  larger  dores.  It  lasted  from  half  an  hour  to  an 
hour  and  a  half.  On  testing  the  reaction  of  the  sweat  in  six  experiments 
we  found  it  neutral  in  four  and  alkaline  in  two. 

SaUvdtion  was  not  so  constant  as  perspiration;  moreover,  the  saliva 
varied  in  quantity  more  than  the  perspiration,  corresponding  in  this 
respect  to  ])ilocarpine.  Salivation  occurred  in  eleven  experiments,  and 
was  absent  in  four.  In  three  it  \Viis  slight,  in  the  rest  free  or  profuse.  It 
began  in  from  two  to  fifteen  minutes,  and  lasted  from  twenty  to  eighty 
minutes. 

Laclirymation  occurred  in  eight  cases,  amounting  in  some  instances 
only  to  suffusion  of  the  eyes,  but  generally  the  tears  trickled  down  the 
face,  so  that  the  j^atient  was  obliged  to  wipe  his  eyes.  It  began  in  six 
to  ten  minutes,  and  lasted  generally  about  twenty  to  thirty  minutes. 

Purgation. — In  the  cases  in  Avhich  it  purged  the  injection  took  effect 
in  from  ten  to  twenty  minutes.  In  two  experiments  the  drug  excited  an 
inclination  to  pass  a  motion;  in  four  experiments  on  the  same  man  it  ]iro- 
duced  a  loose  motion,  one  of  a  green  color,  though  his  bowels  were  opened 
naturally  a  short  time  previously. 

False. — In  one  of  our  four  men  the  pulse  was  always  ver}^  quick;  in 
the  other  three  it  was  natural.  The  effect  on  the  normal  frequency  was 
nil,  or  almost  ml,  though  in  one  man,  on  whom  only  one  observation  was 
made,  it  reduced  the  frequency  ten  to  sixteen  beats.  The  medicine  re- 
duced the  quick  pulse  from  120  to  80  and  60  beats  per  minute.  Our 
observations  are  too  few  to  enable  us  to  speak  with  certaint}^  of  the  influ- 
ence of  muscarin  on  the  pulse,  but  it  appears  to  us  that  the  doses  we 
employed  affected  the  frequency  very  little,  but  the  larger  doses  made  the 
pulse  softer  and  more  compressible. 

JiC'spiration. — The  frequency  of  breathing  was  unaffected  in  every 
experiment. 

SifjliL- — AVe  have  notes  of  the  states  of  the  pupils  in  only  ten  experi- 
ments. In  each  case  the  pupils  became  contracted,  often  considerably; 
the  contraction  beginning  in  about  fifteen  minutes.  The  vision  seemed 
unaffected. 

In  three  of  our  experiments  made  on  one  man  with  the  larger  doses, 
the  drug  induced  vomiting  once,  and  once  nausea. 

In  five  experiments  the  patients  were  obliged  to  pass  urine  in  from 
nine  to  fifteen  minutes  after  the  injection,  and  two  complained  of  supra- 
pubic pain.  In  five  the  drug  produced  a  frequent  hacking  cough.  In 
none  did  headache  or  other  nervous  symptoms  arise.  Like  pilocarj)ine, 
muscarin  favors  sleep. 


MUSCARIN^.  371 

To  show  how  dose  is  the  similarity  in  tne  action  of  muscarin  to  that 
of  pilocarpine  we  give  a  short  account  of  the  effects  of  tlie  latter  drug. 

Jaborandi  (pilocarpine)  flushes  the  face  and  produces  copious  perspira- 
tion and  salivation.  It  increases  the  bronchial  secretion,  exciting  a  slight 
cough,  and  produces  slight  running  at  the  eyes  and  nose.  It  causes  nausea 
and  sickness,  and,  according  to  some  authorities,  diarrhoea,  though  this 
never  occurred  in  the  numerous  experiments  made  by  me  in  conjunction 
with  Mr.  Gould  and  ]\[r.  Murrell.  It  considerably  quickens  the  pulse. 
It  often  produces  headache,  generally  frontal,  with  heaviness  over  the 
eyes,  associated  with  giddiness  and  a  stupid  feeling.  The  sight  is  gener- 
ally hazy,  and  in  about  two-thirds  of  our  observations,  when  the  drug  was 
applied  to  the  eye,  it  contracted  the  pupil,  often  considerably;  tliough, 
Avhen  administered  by  the  stomach  or  hypodermicalh',  it  had  but  little  in- 
fluence on  the  pupil.  It  often  produces  suprapubic  pain,  and  still  oftener 
a  strong  and  irresistible  impulse  to  pass  urine. 

The  similarity  between  the  action  of  muscarin  and  pilocarpine  is  evi- 
dent. There  are,  however,  slight  dilferences.  The  perspiration  and 
salivation  are  generally  greater  after  pilocarpine,  and  last  a  longer  time, 
though  possibly  larger  doses  of  inuscarin  might  in  this  respect  rival  pilo- 
cai-pine.  We  are  led  from  our  experiments  to  conclude  that  muscarin  acts 
rather  more  on  the  lachrymal  glands  than  ]*)ilocarpine.  Muscarin  certainly 
acts  on  the  bowels  far  more  powerfully  than  pilocarpine.  Muscarin,  in- 
ternally administered,  contracts  the  2:)upils  more  strongly  than  pilocarpine. 
On  the  other  hand,  Jaborandi  ])roduces  more  suprapubic  pain,  and  more 
frequently  and  more  strongly  the  impulse  to  pass  water.  Moreover,  pilo- 
carpine produces  headache  and  giddiness,  symptoms  never  yet  noticed  by 
us  after  muscarin.  In  our  experiments  with  muscarin  none  of  our  patients 
complained  of  any  disturbance  of  the  sight,  but  on  this  point  Ave  have  not 
sufficiently  examined  them.  Pilocarpine  produced  a  little  droAvsiness,  but 
Ave  have  not  observed  this  after  muscarin.  In  our  experiments  on  man 
pilocarpine  in  every  case  quickened  the  pulse,  and  as  the  fact  has  been 
amply  corroborated  by  other  observers,  we  may  conclude  that  it  is  estab- 
lished, though  Langley,  in  his  experiments  on  animals,  finds  that  it  sIoavs 
the  heart,  acting  thus  on  animals  like  muscarin.  In  our  experiments  on 
man  muscarin  produced  very  little  effect  on  the  pulse;  if  it  altered  fre- 
quency at  all,  it  reduced  the  number  of  beats. 

Whilst  muscarin  thus  so  closely  resembles  pilocarpine  in  its  action  on 
the  body,  in  one  respect  it  strangely  differs.  Administered  internally, 
either  by  the  stomach  or  subcutaneously,  pilocarpine  slightly  contracts 
the  ]nipil;  topically  applied  to  the  eye  it  strongly  contracts  the  pupil. 
Muscarin,  given  hypodermically,  contracts  the  pupil  far  more  than  pilo- 
carpine; but,  strange  to  say,  when  applied  to  the  eye  itself,  it  Avidely 
dilates  the  pupil.  Thus,  Avhilst  it  is  so  generalh^  antagonistic  to  atropia, 
in  this  one  respect  it  is  similar.  In  respect  to  its  action  on  the  pupil  it 
corresponds  to  gelsemium,  which,  administered  by  the  stomach,  contracts 
the  pupil,  but  applied  locally,  Avidely  dilates  it. 

AVe  tested  the  topical  effect  of  muscarin  in  nine  cases,  using  a  solution 
containing  one  part  of  the  drug  in  ten  of  Avater.  This  solution  produces 
A'ery  little  or  only  transient  smarting.  In  every  case  the  pupil  became 
dilated,  generally  Avidely  dilated,  the  dilatation  beginning  in  from  a  quar- 
ter to  three-quarters  of  an  hour,  and  continuing  about  tAventy-four  hours 
or  a  little  longer. 

So  far  as  Ave  can  jiidge  at  present,  from  only  a  few  careful  observations, 
the  dilatation  verv  little  interferes  Avitli  the  sisrht. 


372  JABORANDI. 

In  some  of  our  experiments  it  seemed  to  us  that  the  doctored  pupil 
contracted  very  slight!}'  before  it  dilated,  whilst  in  other  cases  both 
pupils  certainl}'  at  first  contracted  somewhat.  To  test  the  early  effect 
of  the  local  application  we  dropped  some  of  the  solution  into  a  cat's  eye, 
and  watched  the  effect;  but,  although  after  a  time  the  pupil  widely 
dilated,  we  could  not  detect  any  initial  contraction. 

De  Haen,  Andral,  and  Trousseau  used  agaracus  with  great  success  in 
the  sweating  of  phthisis.  Recently,  Dr.  Peter  has  highly  recommended 
it  in  doses  of  20  to  30  centigrammes  shortly  before  bedtime.  It  is  also 
used  to  arrest  the  secretion  of  milk.  Dr.  Murrell  finds  it  useful  in  the 
sweating  of  disease.  The  white  agaracus  should  be  given  in  doses  of  10 
to  30  grains  of  the  powder,  3  to  6  grains  of  the  extract. 


JABORANDI 


contains  four  alkaloids:  pilocarpine,  on  which  its  effects  mostly  de- 
pend ;  jaborine,  which,  strange  to  sa}^,  has  an  action  like  atropia,  and 
therefore  is  antagonistic  to  the  other  alkaloid,  pilocarpine:  jaborine 
present  only  in  small  quantities:  also  pilocariDiden  and  jaboriden — pilo- 
carpiden  acting  like  pilocariDin,  and  jaboriden  like  jaborin.  Pilocarpine 
can  be  easily  transformed  into  j;iborine,  and  pilocarpidine  into  jaboridin. 
This  active  and  interesting  drug,  long  in  use  in  South  America,  was 
lately  brought  from  Pernambuco  to  Paris  by  Dr.  Continho,  who  recom- 
mended it  as  a  powerful  diaphoretic  and  sialagogue.  Dr.  Continho 
advises  the  patient  to  drink  the  infusion  with  the  susjiended  leaves, 
then  to  go  to  bed  and  cover  himself  with  warm  clothing.  In  about  ten 
minutes  the  face,  ears,  and  neck  become  deeply  flushed,  and  soon  drops 
of  ]3erspiration  break  out  over  the  body,  whilst  at  the  same  time  the 
mouth  waters.  In  a  short  space  of  time  the  perspiration  rapidly  in- 
creases, the  sweat  running  down  the  body  and  soaking  the  clothes,  whilst 
the  salivation  becomes  profuse,  oozing  from  the  mouth,  sometimes  in  an 
almost  continuous  stream.  The  sweating  and  salivation  persist  from 
two  to  four  or  five  hours.  Occasionally  it  happens  that  perspiration  fails 
to  follow  the  medicine,  and  salivation  is  more  frequently  absent;  but 
when  the  drug  fails  to  cause  sweating  it  salivates,  and  vice  versa.  The 
symptoms  come  on,  as  I  have  said,  in  aiiout  ten  minutes,  but  sometimes, 
if  the  external  conditions  are  not  favorable,  the  symptoms  may  be  much 
delayed,  even  for  an  hour  or  longer,  and  often,  perhaps,  are  brought  on 
only  by  brisk  exercise.  Hypodermically  injected,  the  alkaloids  act  in 
three  to  five  minutes. 

The  amount  of  saliva  secreted  may  amount  to  a  pint,  or  a  pint  and  a 
half. 

Pilocarpine  promotes  other  secretions,  as  the  tears,  the  bronchial  and 
intestinal  secretions,  though  to  a  far  less  degree  than  the  salivary  and 
cutaneous  secretion.  Thus  the  eyes  water  slightly,  and  sometimes  there 
is  a  little  running  at  the  nose,  and  a  slight  loose  cough ;  moreover,  some 
observers  state  that  it  relaxes  the  bowels,  an  effect  I  have  never  witnessed 
in  my  numerous  observations.  In  many  cases  these  effects  on  the  tears, 
etc.,  are  absent.     It  does  not  increase  the  biliary  secretion. 


JABORANDI.  373 

Diirnig  the  sweating  the  body  temperature  falls  from  0.4°  to  1.4°  Fall., 
the  average  in  my  observations  conducted  with  Mr.  Gould  being  0.9°. 
The  depression  lasts  from  one  to  four  hours.  This  effect  on  the  tempera- 
ture is  no  doubt  due  to  the  perspiration,  heat  being  lost  by  increased 
evaporation  and  radiation,  more  blood  being  probably  sent  to  the  skin 
during  the  sweating  period. 

In  the  human  sul)ject  jaborandi  always  quickens  the  pulse,  my  original 
assertion  on  this  point  having  been  suljsequently  abundantly  confirmed. 
Strange  to  say,  ]\Ir.  Langley  finds  tliat  it  slows  the  heart  of  warm-blooded 
animals  and  frogs,  and  as  regards  frogs  I  have  repeatedly  verified  this 
statement.  The  pulse  is  increased  in  man  from  40  to  50  beats,  the  ac- 
celerated rate  continuing  for  more  than  four  hours;  at  the  same  time  the 
pulse  is  Aveaker.  Jaborandi  slows,  and  at  last  arrests,  the  heart  of  frogs, 
whether  injected  under  the  skin  or  applied  directly  to  the  heart.  The 
heart  stops  in  wide  diastole.  If,  when  the  heart  is  greatly  slowed,  or 
even  stopped,  a  minute  quantity  of  atropia  is  directly  applied  the  heart 
soon  begins  to  beat  again,  and,  ultimately,  quite  or  almost  recovers  from 
the  effect  of  the  pilocarpine.  Mr.  Langley's  experiments  lead  him  to 
conclude  that  jaborandi  slows  and  arrests  the  heart  by  stimulating  the 
same  nervous  apparatus  that  atropia  paralyzes,  and  so  quickens  the  heart, 
namely,  the  intracardiac  inhibitory  apj)aratus. 

It  is  curious  that  whilst  jaborandi  slows  and  arrests  in  diastole  the  heart  of  frogs, 
and,  according  to  Langley,  of  warm-blooded  animals,  it  greatly  quickens  the  heart  of 
man.  We  see  the  same  contradiction  in  the  action  of  atropia  on  man  and  the  lower 
auimals.  Atropia  quickens  and  strengthens  the  heart  in  man  and  horses,  dogs,  etc., 
whilst  a  full  dose  swallowed,  or  topically  applied,  arrests  the  frog's  heart  in  diastole. 

Jaborandi  at  first  flushes  and  then  pales  the  face.  The  pallor  comes 
on  when  the  sweating  is  active,  showing  that  the  sweating  is  not  due  to 
the  excess  of  blood  sent  to  the  skin. 

It  often  prodtices  froiital  headache,  sometimes  with  giddiness  and  dul- 
iiess.  After  the  internal  administration,  the  sight  frequently  becomes 
hazy,  without  any  alteration  in  the  size  of  the  pupils.  But  the  topical 
application  to  the  eye,  as  I  have  shown,  cattses  decided  contraction  of  the 
pupil.  ]\Ir.  Tweedy  concludes  from  his  investigations  that  jaborandi, 
locally  applied,  causes  (1)  contraction  of  the  pupil;  (2)  tension  of  the  ac- 
commodative apparatus  of  the  eye,  with  approximation  of  the  nearest  and 
furthest  points  of  distinct  vision;  (3)  amblyopic  impairment  of  vision 
from  diminished  sensibility  of  tlie  retina.  These  effects,  however,  do  not 
last  long.. 

Jaborandi  seems'  to  be  slightly  narcotic,  for  patients  often  fell  asleep 
during  oitr  experiments. 

It  not  unfreqtiently  excites  sickness.  'Jhis  can,  in  part,  be  accounted 
for  by  the  large  quantity  of  saliva  swallowed;  often,  indeed,  the  vomit 
consists  solely  of  saliva. 

In  many  cases  jaborandi  j^i'oduces  pain,  often  severe,  over  the  pubes, 
with  a  distressing  irresistible  desire  to  pass  water,  the  pain  at  once  sub- 
siding on  emptying  the  bladder.  As  the  qtiantity  of  urine  is  not  increased, 
it  is  probable  that  jaborandi  excites  contraction  of  the  bladder. 

From  a  few  experiments  I  have  made  I  think  it  probable  that  jaborandi 
promotes  the  secretion  of  milk. 

Jaborandi  affects  children  far  less  easily  than  adults.  A  small  dose, 
as  one-sixtieth  of  a  grain,  induces  local  swelling  without  any  aj^parent 
general  action. 


374  JABORAXDI. 

Pilocarpine  induces  increased  glandular  secretion  by  stimulating  the 
ends  of  secretory  nerves. 

Remedies  excite  sweating  through  their  influence  on  the  nervous  system,  some 
acting  on  the  sweat  centres  in  the  cord,  others  on  the  peripheral  secreting  ap- 
paratus. Acetate  of  ammonia,  plij^sostigma,  nicotine  and  picrotoxine,  acton  tlie 
cord;  pliysostigma  and  picrotoxine  on  tlie  sweat  centres  in  the  medulla.  Pilo- 
carpine acts  on  the  peripheral  nervous  apparatus.     (Marmie  and  Nawrocki.) 

Ott  concludes  that  muscarin  acts  on  the  gland  cells,  for  on  section  of  the  sciatic 
nerve,  in  a  warm-blooded  animal,  aftei-  an  interval  of  nine  days,  stimulation  of 
the  peri|)heral  end  excites  no  perspiration,  showing  that  the  sweating  nervous 
apparatus  is  paralyzed,  but  muscarin  will  still  excite  sweating  in  the  foot  of  the 
leg  with  the  divided  sciatic. 

Pilocarpine  first  stimulates  and  then  paralyzes  the  motor  nerves  of 
involuntary  muscular  fibre.  This  action  explains  the  infrapubic  pain, 
the  contracted  pupil,  and  the  increased  intestinal  movements.  It  also 
causes  contractions  of  the  uterus.  It  is  evident,  from  the  previous  ac- 
count, that  there  is  a  marked  antagonism  between  atropia  and  pilocar- 
jaine.  But  in  three  respects  they  correspond,  for  both  produce  frontal 
headache  and  infrapubic  pain,  Avitli  desire  to  pass  water,  and  both  affect 
children  less  than  adults.  In  order  to  test  the  antagonism  between  these 
two  drugs,  I  have,  on  many  occasions,  administered  pilocarpine,  and 
when  the  sweating  was  profuse,  I  have  injected  hypodermically.  grain 
yi-fj-  of  atroj^ia,  and  in  five  to  ten  minutes  the  skin  became  quite  dry, 
and  salivation  ceased.  Strange  to  say,  not  only  did  atropia  remove  the 
antagonistic  effects  of  pilocarpine,  but  likewise  those  symptoms  common 
to  both  drugs,  namely  headache  and  desire  to  pass  water. 

Jaborandi  is  useful  in  Bright's  disease,  especially  on  the  occurrence 
of  urajmic  symptoms.  If  ursemia  is  urgent  pilocarpine  may  be  injected 
hypodermically,  and  I  have  seen  marked  improvement  follow  this  treat- 
ment. Drachm  doses  of  the  liquid  extract  should  be  given  several  times 
a  day.  Large  doses  of  the  extract  or  full  doses  of  pilocarpine  produce 
much  depression  and  cannot  be  continued. 

Dr.  Berkart  recommends  the  hypodermic  use  of  pilocarpine  in 
asthma;  and  in  bronchitis  when  the  secretion  is  viscid  and  scanty  jabo- 
randi or  its  alkaloid  have  been  used  successfully. 

Pilocarpine,  in  doses  o^'  -gV  gi'ain,,  given  thrice  daily,  will  check  pro- 
fitse  perspiration,  and  I  have  often  found  it  useful  in  the  sweating  of 
jDhthisis,  and  other  observers  have  verified  my  statement. 

G.  Guttmann  and  many  other  writers  highly  commend  pilocarpine 
in  diphtheria.  It  manifests  its  action  locally  on  the  throat.  It  is  stated 
that  the  promotion  of  free  secretion  of  these  parts  detaches  the  false 
membrane.  The  experience  of  others,  however,  is  not  favorable  to  the 
employment  of  pilocarpine  in, this  disease.  Some  employ  pilocarpine  in 
mumps;  and  the  accounts  of  some 'writers  tend  to  show  that  this  drug  is 
useful  in  removing  the  effusions  in  pleurisy,  hydrothorax  and  ascites. 

Bartholow  finds  a  local  application  of  jaborandi  useful  in  baldness,  and 
recommends  the  following: — Extract  of  pilocarpine  an  ounce,  tincture  of 
cantharides  half  an  ounce,  soap  liniment  an  ounce  and  a  half.  To  be 
applied  to  the  scalp  daily.     Possibly  the  action  is  due  to  the  cantharides. 

Xot  only  do  arresters  of  secretion  like  atropia,  etc.,  check  excessive 
pers})iration,  but  sweaters  in  small  doses  are  equally  effectital  in  check- 
ing undue  perspiration.  Thus  I  have  shown  that  pilocarpine,  in  -gV 
grain  doses  thrice  daily,  is  a  most  efficient  remedy  in  excess  perspiration, 
as  in  phthisis.  Agaracus  (muscarin)  and  Dover's  powder  also  check  too 
free  sweating,  and  recently  Dr.   Murrell  has  shown   that  picrotoxine 


GELSEMIUM   SEMPERVIKENS.  375 

effectually  checks  the  night-sweats  of  phthisis  in  yf^  grain  closes.  It 
may  be  administered  in  the  form  of  infusion,  made  with  sixty  or  ninety 
grains  of  the  powdered  leaf,  or  as  tincture,  a  drachm  of  which  is  equal 
to  thirty  grains  of  the  leaf,  or  as  the  alkaloid  pilocarpine,  of  which  half 
a  grain  to  three-quarters  of  a  grain  may  be  given  by  the  stomach,  or  a 
quarter  to  half  a  grain  hypodermically,  or  as  the  liquid  extract  half  a 
drachm  to  a  drachm  three  or  four  times  a  day. 


GELSEMIUM  SEMPERVIRENS. 

This  powerful  drug  has  long  been  employed  in  America.  Its  physio- 
logical action  has  been  investigated  by  Dr.  Koberts,  Bartholow,  Dr.  Ott, 
and  Dr.  Berger. 

Gelsemium,  lately  introduced  into  this  country  as  a  remedy  for  neu- 
ralgia, is  especially  useful  in  non-inflammatory  toothache  and  in  neuralgia 
of  the  nerves  supplying  the  teeth  and  the  alveolar  processes  of  the  jaw. 

Gelsemium  is  a  powerful  paralyzer  and  respiratory  poison.  Its  paral- 
yzing action  is  best  studied  in  the  frog.  In  these  animals  it  often 
produces  tetanus  as  Avell  as  paralysis.  Whether  we  produce  paralysis 
alone,  or  paralysis  followed  by  tetanus,  depends  on  the  dose.  Thus, 
as  a  rule,  with  small  doses  of  the  alkaloid,  we  only  get  paralysis;  with 
rather  larger,  quiverings  and  tetanoid  movements;  and  only  after  large 
doses  decided  tetanus. 

Is  the  paralysis  due  to  the  influence  of  the  drug  on  the  brain,  the  cord, 
the  motor  nerves,  or  the  muscles  ? 

It  paralyzes  the  spinal  cord,  the  motor  nerves  and  the  muscles  being 
unaffected. 

The  tetanus  is  due  to  the  action  of  the  poison  on  the  cord,  and  I  draw 
special  attention  to  the  fact,  that  the  paralysis  of  the  cord  always  pre- 
cedes the  tetanus;  that  gelsemia  has  the  property  of  first  weakening  and 
then  tetanizing  the  cord,  thus  corresponding  to  jaborandi,  buxus  seinper- 
virens,  and  other  drugs. 

Gelsemium  is  a  powerful  respiratory  poison;  indeed,  this  drug  gener- 
ally, if  not  always,  destroys  warm-ljlooded  animals  by  asphyxia,  before  it 
produces  complete  paralysis.  It  produces  no  primary  quickening  of  respi- 
ration, and  does  not  paralyze  the  phrenic  nor  the  intercostal  nerves,  and 
it  acts  after  the  division  of  both  vagi.  It  asphyxiates,  as  Dr.  Burdon 
Sanderson  has  shown,  by  paralyzing  the  automatic  respiratory  centre.  It 
salivates  cats. 

Some  individuals,  however,  as  might  be  expected,  are  much  more  prone 
to  be  affected  than  others.  Thus  a  woman  suffered  from  diplopia,  head- 
ache and  liazy  sight  after  a  second  dose  of  ten  minims,  one  in  four  of 
rectified  spirits;  and,  in  another  case,  two  doses  of  twenty  minims,  at  two 
hours'  interval,  produced  well-marked  symptoms  presently  to  be  described. 
On  the  other  hand,  I  have  given  drachm  doses  hourly,  for  six  hours,  with 
very  slight  effect;  and  in  one  instance  I  gave  twenty  minims  to  a  delicate 
young  woman  every  three  hours  for  several  days,  finally  causing  slight 
heaviness  in  the  eyelids 

Unless  given  in  dangerous  doses  gelsemium  affects  first  and  chiefl}'  the 
eyes  and  brows.  The  symptoms  generally  occur  in  a  certain  order;  not 
without  exceptions,  however,  both  in  the  order  and  number  of  the  symp- 
toms. The  drug  ordinarily  first  produces  pain  in  the  brows,  followed 
soon  by  giddiness,  then  by  pain  in  the  eyeballs,  and  soon  after  by  dimness 


376  GELSEMIUM    SEMPERVIRENS. 

of  sight.  A  larger  dose  produces  double  vision  without  apparent  squinting, 
with  sensation  of  great  lieaviness  in  or  under  the  upper  eyelids,  with 
somewhat  contracted  pupils.  A  still  larger  dose  causes  drooping  of  the 
upper  lid,  sometimes  so  marked  that  the  edges  become  nearly  closed,  and 
can  be  opened  only  by  a  strong  and  painful  effort :  and  after  straining  to 
open  them,  sometimes  the  upper  eyelid  is  so  tired  that  ptosis  for  a  short 
time  becomes  complete.  The  movements  of  the  eyeballs  are  restricted, 
and  associated  in  one  case  with  a  strong  double  internal  squint.  The 
patient  next  complains  of  weakness  in  his  legs,  and  we  have  never  pushed 
the  drug  beyond  the  production  of  this  symptom.  AVhen  decidedly  under 
the  drug's  influence,  the  patient  is  pale,  with  a  heavy  sleepy  look.  Some 
say  their  eyes  feel  sleepy;  others  yawn  frequently,  and  say  they  can  hardly 
keep  awake,  and  when  left  to  themselves  fall  asleep.  Others  complain  of 
dryness  of  the  mouth,  though  the  tongue  looks  moist,  and  to  the  finger 
feels  so.  Some  keep  moistening  the  mouth  with  a  little  water,  even  hours 
after  the  discontinuance  of  the  medicine. 

In  most  instances  these  symptoms  occur,  but  in  some  even  large  doses 
of  the  tincture  induced  only  a  few  of  the  slighter  symptoms.  Thus,  a 
woman  took  a  drachm  dose  hourly,  for  six  hours,  without  exciting  head- 
ache, diplopia,  or  giddiness — only  great  heaviness  of  the  eyes,  and  dimness, 
amounting  almost  to  temporary  loss  of  sight;  though  on  a  former  occasion, 
in  this  very  woman,  we  produced  extreme  diplopia  with  giddiness,  with 
four  one-drachm  doses  of  the  tincture.  Diplopia,  as  we  have  shown,  is 
generally  preceded  by  headache,  giddiness,  and  dimness  of  sight;  but,  in 
one  instance,  diplopia  occurred  without  these  preliminary  symptoms, 
though,  strange  to  say,  on  a  subsequent  occasion,  in  this  same  woman,  with 
a  larger  quantity — that  is,  six  one-drachm  doses  hourly — we  produced 
much  giddiness,  and  mistiness  without  diplopia. 

The  symptoms  from  gelseniium  come  on  early,  and  soon  subside.  A 
single  drachm  dose  rarely  produces  any  marked  symptom,  but  in  from  ten 
minutes  to  a  quarter  of  an  hour  after  the  second  hourly  dose  the  symptoms 
appear,  and  reach  their  highest  point  in  about  half  an  hour,  and  then 
quickly  subside,  most  of  them  ceasing  in  about  an  hour.  With  the  repe- 
tition of  four  or  six  hourly  drachm  doses  the  symptoms  may  persist  six 
or  eight  hours  after  the  last  dose;  but  the  symptoms  are  most  marked 
half  an  hour  after  each  dose,  and  then  decline. 

The  patients  described  the  pain  in  the  head  and  eyes  variously.  It  was 
generally  limited  to  the  forehead,  and  most  marked  just  over  the  eyes. 
Some  call  it  a  dull  sensation  over  the  eyes;  others,  a  heavy  pain;  others, 
a  giddy  pain;  and  one  patient  experienced  pahi  over  the  occiput,  with  a 
sensation  as  of  lifting  the  crown  of  the  liead  off  in  two  places.  Some- 
times this  headache  was  absent,  sometimes  it  follow^ed  instead  of  preceding 
the  otiier  symptoms.  Dull  aching  pain  in  the  eyeballs,  now  and  then 
shooting  in  character,  oocasionally  worse  in  one  ball,  sometimes  followed 
and  sometimes  preceded  the  headache.  The  headache  and  pain  in  the 
eyeballs  were  often  severe,  and  were  intensified  on  moving  the  eyes. 
AVhen  ptosis  was  well-marked  the  effort  to  open  the  eyes  widely  caused 
considera})le  pain,  and  the  patient  seemed  to  get  relief  l)y  closing  his  eyes. 

Giddiness  was  another  prominent  and  early  symptom.  Some  felt  it 
over  the  whole  head ;  but  by  far  the  larger  number  said  it  was  limited  to 
the  Ijrows.  Standing  or  walking  made  it  much  worse.  "When  well-marked, 
the  patients  staggered,  and  were  afraid  even  to  stand,  much  less  walk. 
So  giddy   was   one   patient,  that  he   nearly  fell  off  the  form.     Some 


GELSEMIUM    SEMPERVIRENS,  377 

described  their  heads  as  going  round  and  round.  They  felt  and  seemed 
drunk,  though  without  any  incoherence,  or  mental  excitement. 

In  every  case  the  sight  was  affected;  indeed,  dimness  of  sight  and 
giddiiiess  appear  to  be  the  most  constant  symptoms,  and  may  exist  with- 
out headache,  pain  in  tlie  eyeballs,  or  double  vision.  At  first,  the  sight, 
without  being  misty,  is  not  so  clear  as  usual;  then  slight  mist  comes  before 
the  eyes,  one  patient  comparing  it  to  a  "lot  of  smoke  rising  before  his 
eyes"  and  another  to  a  "thick  veil.'"'  At  last  the  sight  becomes  so  af- 
fected tliat  it  fails  almost  completely,  first  Avith  distant  objects;  then  with 
further  impairment  of  vision,  nearer  and  near  objects  look  liazy.  Gelse- 
mium  alfects,  too,  the  sight  in  animals.  Thus  we  poisoned  a  dog,  and, 
after  the  production  of  slight  muscular  weakness,  the  sight  became 
almost  lost,  for  the  animal  ran  straight  against  objects  without  trying  to 
avoid  them,  evidently  not  seeing  them. 

The  drug  seems  to  produce  two  kinds  of  diplopia,  one  much  more 
persistent  than  the  other.  As  to  the  transient  kind,  we  find  it,  on 
many  occasions,  a  very  passing  phenomenon,  lasting  only  a  few  seconds, 
then  disappearing,  then,  after  a  few  minutes,  reappearing.  In  this  tran- 
sient form  images  in  the  median  vertical  line  appear  double,  distant  objects 
at  first  undergoing  the  duplication.  Sometimes  the  patient  was  conscious 
of  the  onset  of  the  diplopia;  thus  one  Avoman  said,  "I  know  it  is  now 
coming  on;  I  feel  such  a  heavy  weight  under  my  upper  eyelid.''  The 
double  vision  then  came  on,  and,  with  the  heaviness,  passed  away  in  a 
few  seconds.  One  image  was  higher  than  the  other;  the  images  in  this 
respect  varying  much.  Mr.  T.  Fox  rapidly  recorded,  from  the  patient's 
]ips,  the  phenomena  occurring  as  fast  as  they  could  be  written:  "One 
gas  jet  appears  about  six  inches  above  the  other,  and  there  are  six  inches 
between  them  horizontally;  the  upper  one  is  to  the  left;  now  the  right  is 
uppermost;  now  the  left  slightly  again;  going  over  to  the  right  now  again; 
exactly  over  one  another  and  quite  close  together;  now  again  separated, 
left  the  highest;  now  over  one  another."  With  other  patients  the  two 
images  seem  on  a  level.  Sometimes  the  drug  produces  only  this  transient 
kind  of  diplopia;  at  other  times  both  kinds;  and  sometimes  one  kind  pre- 
ceded the  other,  the  transient  usually  preceding  tlie  more  constant  form, 
recurring  from  time  to  time,  while  the  constant  form  persisted. 

The  phenomena  of  the  constant  form  of  diplopia  follow  a  definite 
order,  and  take  place  in  the  upper  half  only  of  the  field  of  vision.  They 
occur  first  with  objects  held  at  the  extreme  right  or  left  of  the  visual 
field;  and,  as  the  patient  passes  more  under  the  influence  of  the  drug, 
then  with  objects  held  nearer  and  nearer  the  middle  line;  and  at  last, 
usually  for  a  short  time  oidy,  objects  in  the  median  vertical  plane  seem 
double.  As  the  effect  of  the  drug  wears  off,  the  double  vision  disappears 
in  the  inverse  order.  The  outer  lateral  image  is  the  higher,  and  the 
further  the  object  is  carried  to  the  right  or  left  the  greater  is  the  horizon- 
tal and  vertical  distance  between  the  images.  When  a  colored  glass  is 
placed  before  either  eye  the  outer  and  higher  image  is  seen  by  the  covered 
eye.  When  the  object  is  carried  high  above  the  head  the  two  images 
gradually  coalesce,  and  the  objects  looks  very  much  thinner,  "  like  a 
thread."  AVith  well- developed  diplopia  there  is  impaired  movement  of 
tlie  eyeball,  chiefly  alfecting,  as  far  as  can  be  ascertained,  the  external 
and  internal  rectus,  especially  the  external,  for  the  outward  and  inward 
movement  of  the  eye-ball  is  less  free  than  before  the  action  of  the  medi- 
cine.    The  ball  appears  to  be  moved  by  a  greater  effort,  so  that  when 


378  GELSEillUM    SE3IPERVIRENS. 

carried  as  far  as  the  weakened  muscles  are  capable  it  oscillates;  as  though 
the  patient,  witli  a  great  effort,  moved  it  as  far  as  he  could,  and  then  the 
tired  muscles  gave  way  a  little,  but  being  roused  to  an  effort,  they  carried 
the  eye  back  again,  the  frequent  repetition  of  this  effort  giving  rise  to  an 
oscillation. 

The  external  rectus  is  generally  first  affected,  and  not  infrequently 
one  external  rectus  sooner  than,  and  in  excess  of,  the  other.  Even  when 
the  diplopia  is  strongly  marked  the  loss  of  power  over  the  muscles  is  not 
very  great,  and  there  is  no  obvious  squinting.  (We  may  remark  here  that 
we  could  not  detect  aiiy  squinting  during  the  transient  form  of  diploiiia.) 
Then,  as  the  patient  becomes  still  more  affected,  ptosis  supervenes,  and  a 
great  part,  or  the  Avhole  of  the  upper  half,  of  the  field  of  vision  is  cut  off. 
The  loss  of  power  in  the  eye  muscles  is  then  more  marked,  but  without 
the  occurrence  of  obvious  squinting.  At  this  time  symptoms  no  longer 
follow  the  order  previously  described,  but  assume  various  forms,  often 
changing  rapidly.  Thus,  whilst  on  one  side  the  outer  image  is  the  higher, 
if  the  object  is  carried  to  the  other  side  of  the  field  the  inner  image 
becomes  the  higher;  or,  perhaps,  for  the  first  few  seconds  the  outer  and 
then  the  imier  is  the  higher. 

In  twenty-two  out  of  thirty-three  series  of  observations  the  pulse  re- 
mained unaffected  in  frequency,  Avhilst  in  the  remaining  eleven  it  was 
accelerated,  the  increase  ranging  from  six  to  twelve  beats  in  the  minute. 
Curiously  enough,  even  in  the  same  patients  the  effects  were  variable,  for 
although  on  some  occasions  the  drug  accelerated  the  pulse,  on  others  it 
failed  to  affect  it.  This  was  not  a  mere  question  of  dose,  for  an  increase 
in  the  dose  did  not  affect  the  result.  With  a  patient  fully  under  the  in- 
fluence of  the  drug  we  were  inclined  to  think  the  pulse  became  a  little 
smaller  and  softer.  These  observations  show  that  gelsemium  produces 
little  if  any  effect  upon  the  circulation,  a  conclusion  confirmed  by  observa- 
tions on  the  lower  animals. 

Dr.  Burdon  Sanderson  concludes,  from  a  kymographic  experiment  on 
a  rabbit,  that  gelsemium  exerts  no  influence  on  the  blood  pressure. 

Gelsemium  acts  less  powerfully  upon  the  respiratory  centre  in  man 
than  in  the  lower  animals,  or,  perhaps,  to  speak  more  accurately,  we 
should  say  that  in  the  human  subject  other  parts  of  the  nervous  system 
are  affected  before  the  respiratory  tract.  Thus  in  man  the  drug  produces 
giddiness,  pain  in  the  head,  loss  of  sight,  diplopia,  and  ptosis  before  res- 
piration is  in  any  way  affected.  This  ptosis  may  be  so  complete  that  the 
eyes  cannot  be  opened,  and  the  sight  may  be  temporarily  almost  destroyed, 
yet  the  breathing  will  not  be  altered  in  character,  or,  at  all  events,  will 
become  only  slightly  more  superflcial.  It  may  be  said  that  the  symptoms 
we  have  enumerated  may  have  been  overlooked  in  the  lower  animals.  I, 
of  course,  cannot  answer  for  the  pain  in  the  head  and  giddiness,  but  I  am 
enabled  to  speak  positively  as  to  the  absence  of  ptosis.  I  frequently 
noticed  that  Avhen  an  animal  was  so  fully  under  the  influence  of  the  drug 
as  to  be  on  its  side  in  a  condition  of  absolute  helplessness  it  was  still  able 
to  open  its  eyes  Avidely,  apparently  without  the  slightest  effort. 

In  the  lower  animals  gelsemium,  as  we  have  seen,  acts  first  on  the 
respiratory  centre,  then  on  the  spinal  cord.  In  man,  however,  the  muscles 
of  the  upper  eyelids,  or  more  probably  their  motor  nerves,  are  considera- 
bly affected  before  either  the  cord  or  respiratory  centre.  Moreover,  if  the 
cases  of  poisoning  are  correctly  reported,  Ave  are  justified  in  concluding 
that  in  man  the  drug  acts  upon  the  spinal  cord  before  it  involves  the 


GELSE^IIU^r    SEMPERVIRENS. 


879 


respiratory  centre,  for  in  several  instances  it  is  recorded  that  the  patient 
has  recovered  from  a  condition  of  complete  paralysis.  In  my  experi- 
ments on  cats,  rabi)its,  and  dogs  we  found  that  the  animal  died  from  as- 
phyxia before  there  was  any  great  impairment  of  voluntary  power. 

Gelsemium,  as  I  have  already  stated,  has  been  highly  praised  in  the 
treatment  of  cough,  especially  in  "  convulsive  or  spasmodic  cough." 

For  practical  purposes  we  recognize  three  different  kinds  of  cough: — 

1.  Where  the  expectoration  is  free,  and  the  cough  is  not  in  excess  of 
the  expectoration, 

2.  Where  the  expectorating  power  is  diminished,  as  in  emphysema  and 
fibroid  degeneration  of  the  lung.  In  fibroid  degeneration,  owing  to  the 
great  induration  and  thicke.iing  of  the  pleura,  there  is  little  or  no  expan- 
sion, and  the  air  cannot  be  drawn  into  the  small  bronchial  tubes  behind 
the  mucus,  Avhich  is  consequently  not  expelled.  In  these  cases,  although 
the  expectoration  is  slight,  the  cough  is  often  troublesome,  and  not  in- 
frequently very  violent. 

3.  Where  there  is  excessive  excitability  of  the  respiratory  centre,  and 
consequently  a  small  secretion  of  mucus  ■(suffices  to  set  up  violent  and 
freqent  cough. 

In  every  case  the  main  object  of  our  treatment  is  to  diminish  the 
secretion  of  the  mucus  in  the  bronchial  tulles.  This  method  must  be 
chiefly  relied  on  in  the  first  and  second  varieties.  In  the  third,  we  must 
have  recourse  to  the  administration  of  sedatives,  and  ether,  chloroform, 
opium,  and  gelsemium  will  be  found  beneficial. 

I  have  carefully  watched  for,  but  have  been  unable  to  detect  in  gelse- 
mium, any  influence  on  the  mental  faculties.  It  has  been  employed  as 
a  mild  narcotic.  Patients,  when  under  the  influence  of  gelsemium,  look 
dull  and  heavy  from  the  drooping  eyelids,  and  often  feel  sleepy,  but  when 
asked  if  they  are  conscious  of  any  mental  depression  they  always  answer 
decidedly  in  the  negative.  Xor  is  cutaneous  sensibility  affected.  I  have 
tested  sensibility  roughly  by  pricking  the  skin  and  pinching,  and  also  in 
two  cases  by  the  use  of  the  compasses,  but  Avas  unable  to  detect  any  loss 
of  sensation,  either  in  the  face  or  forearm,  although  the  patients  to  whom 
I  have  more  especially  referred  had  taken  for  six  consecutive  hours  drachm 
doses  of  the  tincture,  and  were  fully  under  the  influence  of  the  drug.  I 
was  led  to  pay  particular  attention  to  the  action  of  gelsemium  on  the  gums 
from  the  success  winch  has  attended  its  administration  in  neuralgia  of 
these  parts.  One  patient,  on  both  occasions  on  which  I  experimented  on 
him,  complained  spontaneously  of  a  numb  pain,  and  a  little  tenderness 
along  the  teeth  and  the  edges  of  the  gums  of  the  u]-»per  jaw.  I  have 
never,  however,  in  any  case  been  enabled  to  detect,  either  by  pinching  or 
by  the  use  of  sharp  instruments,  any  loss  of  sensation  in  the  parts. 

In  addition  to  these  observations  on  patients  I  made  six  temperature 
experiments  on  rabbits,  but  the  results  obtained  Avere  simply  }iiL  I  soon 
found— a  fact  with  which  I  was  previously  acquainted — that  in  these  ani- 
mals fright  exerts  a  marked  influence  on  the  temperature.  The  mere 
holding  the  animal's  legs,  or  placing  it  on  its  side  with  a  view  of  intro- 
ducing the  thermometer  into  the  rectum,  will  rapidly  reduce  the  tem- 
perature by  two  degrees.  My  conclusions  on  the  point  in  question  have 
consequently  been  drawn  entirely  from  observations  on  patients. 

Strange  to  say,  the  effect  of  an  internal  dose  of  gelsemium  is  opposite 


380  GELSE3IIUM    SEMPERVIRENS. 

to  that  occasioned  by  its  application  to  the  eye  itself.  When  given  by 
the  mouth  in  doses  sufficient  to  produce  symptoms,  the  drug,  in  every 
instance  but  one,  caused  contraction  of  the  pupil;  indeed,  in  the  case  in 
which  the  drug  i)roduced  weakness  of  the  legs,  with  a  strong  double 
internal  squint,  the  pupils  were  contracted  to  a  pin's  jjoint.  In  the  ex- 
ceptional patient  just  referred  to,  on  Avhom  I  made  two  observations, 
though  on  each  occasion  I  jiroduced  great  giddiness,  laziness,  suscepti- 
bility to  light,  and  diplopia,  the  pupils  did  not  contract,  but  manifested 
a  very  unsteady  condition,  varying  greatly  in  size,  in  rapid  alternation, 
■without  any  apparent  cause.  In  another  patient  the  pupils  strongly 
contracted  when  exposed  to  light,  but  they  dilated  freely  in  a  darkened 
room,  and  when  they  recontracted  on  exposure  to  light  they  seemed  in 
an  unstable  condition,  oscillating  a  good  deal.  The  eontraction  of  the 
pupil  does  not  cease  on  the  disapiDcarance  of  diplopia  or  dimness;  in- 
deed, when  the  dimness  passes  away,  the  contraction  of  the  pupil  may 
increase. 

In  cases  of  accidental  poisoning  it  is  reported  that  during  complete 
general  paralysis  the  pupils  are  widely  dilated,  whence  it  might  be  in- 
ferred that  the  condition  of  the  pupil  depends  on  the  dose — a  moderate 
dose  contracting,  a  very  large  one  dilating,  the  j^upil.  This  inference  is 
possibly  in  part  true,  but  the  dilatation  may  be  due  likewise  to  the 
asphyxia  consequent  'on  large  doses.  Dr.  0.  Berger  finds,  and  my  obser- 
vations confirm  his  statements,  that  dilatation  of  the  pupils  in  poisoned 
animals  occurs  only  when  asphyxia  from  paralysis  of  respiration  has  set 
in,  and  that  artificial  respiration  at  once  causes  the  pupils  to  contract. 

On  the  other  hand,  the  topical  application  to  the  eye  dilates  the 
pupil.  In  the  first  instance  I  employed  a  tincture  (1  in  10)  of  the 
American  liquid  extract.  These  prej^arations  dilate  the  pujiil  slightly, 
but  they  excite  great  irritation.  Subsequently,  I  employed  the  alkaloid 
prepared  by  Mr.  Gerrard — one  grain  in  twenty  minims  of  water,  a  solu- 
tion Avhich  causes  scarcely  any  smarting.  Mr.  T.  Fox  and  Mr.  Sydney 
Pearse  made  for  me  nineteen  observations.  A  few  drops  of  the  solution 
were  put  into  one  eye,  and  in  each  case  this  trial  pupil  became  Avidely 
dilated,  the  dilatation  usually  beginning  in  about  thirty  minutes.  Not 
only  does  the  pupil  dilate,  but  the  muscle  of  accommodation  becomes 
paralyzed  and  the  sight  affected;  the  vision  again  becomes  nearly  natural 
in  twenty-four  hours,  but  the  pupil  remains  dilated  much  longer,  some- 
times, indeed,  for  a  week,  or  even  a  fortnight. 

The  fact  that  the  internal  administration  contracts  the  pupil  led  me 
to  examine  carefully  whether  the  local  application  to  the  eye  causes 
any  primary  contraction;  and  in  three  instances  I  thought  I  detected 
very  slight  contraction,  lasting  only  a  few  minutes. 

The  local  application  also  dilates  the  pupils  of  rabbits  and  cats. 
The  pupil  of  a  cat  being  extremely  sensitive,  I  thought  that  if  the  local 
ai:)plication  did  cause  primary  contraction  I  should  detect  it  best  in  this 
animal. 

In  five  observations  the  pupils  in  each  instance  became  decidedly 
contracted  before  dilating.  In  one  instance  the  contraction  began  in 
two  minutes,  in  another  it  was  delayed  fifteen  minutes,  the  average  time 
being  ten  minutes.  Its  average  duration  Avas  twenty-four  minutes,  and 
it  was  followed  by  wide  dilatation. 

I  have  said  that  the  local  application  dilates  the  pupils,  but  I  must 
add  that  in  rabbits  absorption  sometimes  takes  place  so  readily,  and 


GELSEMIUM    SEMPERVIRElSrS.  381 

these  animals  are  so  easily  affected  by  the  poison,  that  the}'  become 
asphyxiated,  and  die  before  the  pupil  has  time  to  dilate.  The  con- 
tracted pupils  due  to  the  internal  administration  of  the  drug,  and  the 
dilated  pupils  due  to  its  local  aj)plication,  are  both  associated  with  dim- 
ness of  sight. 

I  have  said  that  the  internal  administration  of  gelsemium  contracts  the 
pupil  in  man  and  the  lower  animals,  and  that  dilatation  occurs  only  on 
the  supervention  of  asphyxia,  which  at  once  disappears  under  the  em- 
ployment of  artificial  respiration,  showing  that  this  dilatation  is  due  to 
the  asplwxia  and  not  to  the  drug.  It  occurred  to  me  that  the  internal 
administration  would  probably  dilate  the  pupil,  but  that  a  dose  adequate 
to  produce  this  effect  so  quickly  jmralyzes  the  respiratory  centre  that 
before  the  drug  has  time  to  effect  dilatation  the  animal  dies  asijliyxiated. 
To  ascertain  the  validity  of  our  conjecture  I  made  a  rabbit  insensible 
with  seven  grains  of  chloral,  then  inserted  a  cannula  into  its  trachea,  and 
injected  into  the  subcutaneous  tissues  of  the  axilla  thirty  drops  of  the 
liquid  extract,  and  at  once  commenced  artificial  respiration,  to  prevent 
the  advent  of  any  asph5'xia.  In  seventeen  minutes  I  thought  the  pupils 
were  a  little  contracted;  in  twenty-six  minutes  well-marked  signs  of 
paralysis  set  in,  shown  at  first  by  a  difhculty  in  keeping  up  the  head;  in 
half  an  hour  the  animal  could  not  raise  its  head  off  the  table,  whilst  it 
still  retained  considerable  power  over  its  trunk  and  extremities.  At  this 
point  the  eyes  became  prominent  and  the  pupils  began  to  dilate,  and  in 
thirty-four  minutes  the  animal  tumbled  over  on  its  side,  and  then  I 
noticed  that  the  pupils  were  decidedly  larger  and  the  eyes  more  prom- 
inent; but  as  at  the  expiration  of  an  hour  the  pupil  had  not  become 
widely  dilated,  I  repeated  the  thirty  minims  of  liquid  extract,  injecting 
it  in  two  places  into  the  subcutaneous  tissue.  Paralysis  rapidh'  increased, 
till  it  became  complete  in  the  anterior  part  of  the  body,  though  still  the 
rabbit  had  considerable  power  over  its  hind  legs;  but  at  last  these  also 
became  almost  completely  paralyzed,  and  the  animal  lay  on  its  side  in  a 
helpless  state.  As  the  paralysis  advanced  the  pupil  dilated  somewhat, 
till  at  last  it  became  above  double  its  original  size,  though  it  never 
reached  the  degree  of  dilatation  observable  in  man  and  cats  after  the 
local  application  of  the  alkaloid.  I  noticed  that  the  animal  retained  the 
power  of  closing  its  eyes  quickly  and  strongly,  even  after  almost  com- 
plete general  paralysis,  whence  I  conclude  that  the  seventh  or  some  of 
its  branches  is  one  of  the  last  nerves  to  undergo  paralysis. 

While  performing  this  experiment  I  noticed  that  the  anterior  part  of 
the  body  was  first  and  most  severely  paralyzed,  for  after  the  anterior 
limbs  were  almost  helpless  the  animal  retained  a  good  deal  of  power  over 
the  posterior  extremities,  which  likewise  at  last  became  helpless. 

On  another  occasion  I  repeated  this  experiment,  and  continued  arti- 
ficial respiration  for  two  hours  and  ten  minutes.  During  this  time  I 
injected  under  the  skin  a  drachm  of  the  liquid  extract  three  times,  com- 
pletely paralyzing  the  rabbit.  At  first  the  pupils  became  slightly  con- 
tracted, but  under  the  full  effect  of  the  drug  they  were  slightly  dilated. 
This  experiment  shows  clearly  that  the  internal  administration  of  a  large 
dose  will  dilate  the  pupil,  though  not  considerably. 

To  sum  up  the  effects  of  gelsemium,  it  has  very  little  effect  on  the 
brain  beyond  inducing  some  drowsiness.  It  tetanizes  and  paralyzes  by 
its  action  on  the  spinal  cord.     It  paralyzes  the  respiratory  centre;   it 


882  GRINDELIA   ROBUSTA. 

probably  paralyzes  the  peripheral  parts  of  some  branches  of  the  occulo- 
motor  nerve.     It  slightly  dei)resse3  the  heart  by  its  direct  action. 

I  have  tried  gelsemium  with  decided  success  in  several  cases  of 
neuralgia  of  the  dental  nerves,  even  when  the  teeth  were  carious.  Un- 
fortunately, in  several  cases,  the  necessary  dose  to  relieve  pain  produced 
much  giddiness,  haziness  and  sometimes  sleepiness,  a  considerable  draw- 
back. In  some  instances  ten  minims  three  times  a  day  produced  these 
toxic  symptoms.  To  a  girl  of  fourteen,  suffering  with  neuralgia  of  the 
supra-orbital  branch  of  the  fifth,  I  gave  ten  minims  of  the  tincture  three 
times  a  day,  and  each  dose  produced  complete  ptosis  of  the  neuralgic 
eye,  lasting  an  hour  or  longer. 

I  have  found  tincture  of  gelsemium  in  ten-minim  doses  thrice  daily 
useful  in  some  cases  of  Meniere's  disease.  In  five-drop  doses  repeated 
every  quarter  of  an  hour  the  tincture  is  said  to  be  useful  in  gall-stones, 
and  in  one  case  in  my  experience  it  has  repeatedly  averted  an  attack.  In 
fact,  the  patient  gets  relief  in  five  minutes  after  the  first  dose,  and  all 
the  sooner  when  he  walks  about. 

A  tumbler  or  two  of  hot  water  with  a  teaspoonful  of  carbonate  of 
soda  is  said  to  relieve  the  pain  of  gall-stones. 

It  has  been  employed  in  tetanus  and  in  mania  with  sleeplessness. 

It  is  highly  spoken  of  in  sleeplessness,  especially  of  drunkards  and 
from  over-excitement. 

It  sometimes  benefits  asthma,  and  is  useful  in  ovarian  neuralgia  and 
dysmenorrhoea,  and  in  many  of  the  distressing  symptoms  occurring  at 
the  change  of  life. 


GRINDELIA   ROBUSTA. 

This  composite  plant  has  acquired  a  considerable  reputation  in 
America,  where  it  is  used  as  an  antidote  in  poisoning  by  the  rhus  toxi- 
codendron, and  as  a  remedy  in  asthma,  and  in  allied  diseases.  The  prep- 
aration of  the  liquid  extract  has  proved,  in  many  cases,  so  serviceable 
that,  although  my  own  experience  with  respect  to  it  has  been  slight,  it 
is  so  far  favorable  that,  coupled  with  the  strong  testimony  I  hear  from 
jnedical  friends,  I  am  induced  to  give  a  brief  account  of  this  jjlant, 
though  I  must  own  I  have  been  greatly  disappointed  with  it,  and  it  has 
failed  to  realize  the  expectations  raised  by  the  recommendations  of 
various  writers.  It  slows  the  heart  and  respiration.  Large  doses  dilate 
the  pupil  and  cause  sleeji,  when  the  cutaneous  sensibility  and  reflex 
movements  are  lessened.  It  kills  by  paralyzing  the  muscles  of  respira- 
tion. 

Grindelia  is  employed  in  two  ways.  Some  give  it  in  three-grain 
doses  of  the  extract  thrice  daily  to  prevent  an  asthmatic  attack;  others 
give  it  to  cut  short  the  attack  in  twenty  to  thirty-minim  doses  of  the 
liquid  extract  every  half  hour,  or  hourly,  beginning  at  the  very  onset  of 
the  paroxysm. 

It  is  also  used  in  chronic  pyelitis  and  chronic  cystitis. 


BELLADONNA.  383 


BELLADONNA. 

Certain  animals,  like  pigeons  and  rabbits,  appear  to  be  almost  in- 
susceptible to  tbe  influence  of  belladonna. 

Dr.  Horatio  Wood  has  shown  that  the  local  application  of  belladonna 
does  not  dilate  the  pupil  of  pigeons,  which  supplements  Wharton  Jones's 
observation  that  when  administered  internally  the  drug  has  no  effect  on 
the  eye.  Stramonium  and  hyoscyamus,  as  well  as  belladonna,  have  very 
little  action  on  pigeons,  and  with  these  substances  it  is  indeed  almost 
impossible  to  kill  these  birds.  Two  grains  of  atropia  administered  hypo- 
dermically  are  required  to  kill  a  pigeon ;  and  Calmus  found  that  fifteen 
grains  are  required  to  kill  a  rabbit.  It  is  said  that  vegetable  feeders  are 
but  little  affected  by  belladonna,  but  that  it  is  a  powerful  poison  to 
flesh-eaters;  thus  belladonna,  it  is  asserted,  has  very  little  effect  on 
horses  and  donkeys. 

The  preparations  of  belladonna  are  in  frequent  use  for  external  ap- 
plications; no  other  applications  are  so  effective  for  the  relief  of  pleuro- 
dynia and  the  hyper-sensitiveness  of  the  skin  and  irritability  of  the 
muscles  of  the  chest  in  phthisis  as  the  liniment  or  plaster  of  belladonna. 
The  liniment  is  preferable  to  the  plaster,  being  stronger  and  cleaner, 
and  should  be  rubbed  over  the  tender  and  painful  part  several  times 
daily,  according  to  the  severity  of  the  pain.  Although,  as  a  rule,  the 
liniment  is  preferable,  yet  in  certain  cases  of  pleurodynia  the  constant 
application  of  the  plaster  gives  more  relief. 

The  liniment  of  belladonna,  or  the  ointment  of  its  alkaloid,  is  some- 
times used  in  facial  neuralgia. 

Myalgia  often  yields  to  belladonna,  although  opium  preparations,  as 
the  linimentum  saponis  cum  opio,  sometimes  succeed  better. 

An  attack  of  lumbago  having  perhaps  affected  the  whole  loins  often 
leaves  behind  it  one  painful  spot,  which  may  distress  the  patient  only 
when  the  body  is  moved  in  one  direction. 

This  remnant  of  lumbago  generally  resists  the  usual  methods  of 
treatment,  and  is  perhaps  driven  from  one  spot  only  to  reappear  at 
another;  but  a  large  belladonna  plaster  will  generally  relieve  or  altogether 
remove  this  lingering  pain. 

Belladonna,  employed  either  internally  or  externally,  checks,  and 
even  suppresses,  the  secretion  of  the  glands.  Tliis  is  true  of  the  mam- 
mary, sudoriparous,  and  salivary  glands,  and  possibly  of  other  glands. 
Belladonna,  it  is  well  known,  will  arrest  the  secretion  of  milk,  and  is 
employed  with  great  advantage  when,  from  any  cause,  a  mother  being 
unable  to  suckle  her  child,  the  breasts  become  swollen,  exquisitely  pain- 
ful, and  threaten  to  inflame  and  suppurate,  unless  the  tension  of  the 


384  BELLADONNA. 

ducts  is  relieved.  If  the  milk  cannot  be  drawn  off  artificially,  the  secre- 
tion must  be  sup2)ressed  by  means  of  belladonna,  which  should  be  applied 
early,  before  inflammation  lias  set  in,  and  then,  in  a  few  hours,  the 
swollen,  painful  breast  gradually  diminishes  and  soon  becomes  soft, 
comfortable,  and  painless.  But  if  inflammation  has  set  in,  and  tbe 
breasts  become  tense,  shiny,  hard,  knotty,  red,  and  acutely  jxiinful,  the 
continuous  apj^lication  of  belladonna  for  twenty-four  or  forty-eight 
hours  will  even  then  often  remove  the  inflammation  and  tension,  and 
arrest  impending  abscess.  The  rapid  relief  it  gives  in  these  cases  Avill 
greatly  astonish  any  one  unaccustomed  to  its  use.  It  should  be  em- 
ployed in  all  cases,  no  matter  how  far  the  inflammation  has  advanced, 
and  it  will  often  arrest  the  progress  of  an  abscess,  otherwise  almost  cer- 
tain to  maturate.  Even  when  it  fails  to  prevent  suppuration,  yet  it  will 
reduce  inflammation,  subdue  much  of  the  pain,  and  greatly  limit  the  in- 
evitable abscess. 

The  liniment,  the  extract  mixed  with  an  equal  quantity  of  glycerine, 
the  ointment,  or  a  drachm  of  the  tincture  to  an  ounce  of  olive  oil,  or  two 
drachms  of  the  liniment  mixed  with  an  ounce  of  lard,  should  be  rubbed 
especially  over  the  areola  around  the  nipple.  The  liniment  is  speedily 
effectual. 

Frequent  fomentation  with  very  hot  water,  unless  cooler  water  should 
be  found  more  agreeable  and  soothing,  is  an  excellent  adjunct,  but  the 
nurse  must  be  cautioned  to  wipe  the  skin  perfectly  dry,  or  friction  with 
the  liniment  will  perhaps  produce  a  sore.  Dr.  Gabb,  of  Hastings,  tells 
me  that  he  finds  the  combination  of  belladonna  with  the  application  of 
an  ice  bag  most  useful  in  milk  abscess.  He  smears  the  nipple  and  sur- 
rounding parts  with  extract  of  belladonna  and  glycerine,  and  covers  the 
breast  with  an  ice  bag.  The  a2:)plication  of  ice  must  be  strictly  continu- 
ous. 

Belladonna  will  arrest  not  only  the  secretion  of  milk,  but  the  secre- 
tion of  perspiration.  A  man  forty-five  years  old  had  been  troubled  for 
many  months  with  profuse  sweating  of  the  right  side  of  the  face  and 
neck,  which  used  to  break  out  on  the  slightest  exertion,  or  when  near  a 
fire,  or  if  excited,  so  that  the  perspiration  ran  down  his  face  and  neck  in 
streams,  soaking  his  collar  and  the  band  of  his  shirt.  His  face  was 
neither  red  nor  injected,  but  the  sweat  produced  an  abundant  croj)  of 
miliary  vesicles  strictly  limited  to  one-half  the  face. 

The  liniment  of  belladonna,  applied  two  or  three  times  a  day,  con- 
siderably abated  this  excessive  sweating,  and  reduced  it  to  little  more 
than  the  natural  amount. 

The  effect  of  belladonna  in  this  instance  led  me  to  test  its  influence 
over  other  kinds  of  sweating.  If  used  twice  or  thrice  a  day  the  liniment 
will  completely  check  the  sweating  that  soaks  the  pillows  and  bedews  the 
heads  and  faces  of  young  children  who  have  been  sleeping.  After  a  few 
days  the  application  may  be  discontinued,  and  there  will  be  no  return 
of  the  perspiration.  Again,  many  healthy  adults  are  troubled  all  their 
lives  with  profuse  sweating  of  the  hands  or  feet,  sometimes  so  copious 
as  to  run  off  in  drops,  and  especially  noticeable  at  the  tips  of  the  fingers, 
and  the  ball  of  the  thumb.  Belladonna  liniment  rubbed  into  the  hands 
three  or  four  times  a  day  will  often  gradually  diminish  and  sometimes 
completely  arrest  this  annoying  affection,  although,  no  doubt,  there  are 
cases  in  which  the  treatment  fails.     The   sweating   may,  at  least,  be 


BELLADONNA.  385 

arrested  for  a  considerable  time,  and  sometimes  the  good  effects  are 
permanent. 

Since  the  publication  of  the  foregoing  remarks  I  have  made  many 
fresh  observations,  which  confirm  the  efficacy  of  belladonna  in  checking 
sweating.  Thus,  a  j^atient,  who  all  her  life  had  suffered  from  profuse 
sweating  of  the  left  side  of  the  body,  completely  checked  the  sweating 
by  rubbing  belladonna  ointment  into  the  face  twice  or  three  times  a 
day.  Again,  in  cases  of  local  sweating  of  the  loins,  over  a  surface  a  little 
larger  than  the  hand,  the  j)erspiration  exciting  a  copious  eruption  of 
eczema,  belladonna  checked  the  joerspiration,  and  likewise  cured  the 
eczema. 

Many  experiments  of  the  following  kind  were  instituted.  On  several 
occasions  a  patient,  after  undergoing  a  sweating  in  the  hot-air  bath,  was 
rubbed  on  one  side  of  the  face  for  a  quarter  of  an  hour  three  times  a  day 
for  two  or  three  days  with  belladonna  ointment.  The  bath  of  the  same 
temperature  and  duration  was  then  repeated,  when  it  was  observed  that 
the  sweating,  both  during  the  process  and  after,  was  very  greatly  lessened ; 
also  the  effect  was  general,  although  the  ointment  was  aj^plied  only  to 
one  side  of  the  face. 

In  some  cases  the  ointment  was  rubbed  into  the  chest,  but  the  effects 
were  much  less  marked  than  when  applied  to  the  face,  possibly  because 
less  ointment  was  absorbed. 

As  the  local  application  checked  sweating  over  the  whole  body  it  was 
supposed  that  it  acted  by  absorption,  and  this  led  to  the  internal  admin- 
istration of  belladonna.  The  repressive  effect,  however,  was  apparently 
decidedly  less  than  when  locally  applied,  possibly  because  the  amount  of 
the  drug  swallowed  was  less  than  that  absorbed  by  the  skin.  Still,  no 
doubt  the  internal  administration  of  belladonna  does  effectually  control 
sweating,  ^particularly  in  the  case  of  weakly  children  perspiring  pro- 
fusely after  exertion,  and  whilst  sleeping. 

In  the  curious  case  of  a  middle-aged  man,  who,  after  much  mental 
worry,  suffered  from  excessive  sweating  of  both  cheeks  while  eating — 
the  tendency  being  promoted  by  hot  meat,  or  vinegar — the  sweating 
ceasing  immediately  after  the  meal,  ten  drops  of  tincture  of  belladonna 
thrice  daily  checked  the  sweating  completely.  This  man  passed,  at 
times,  a  profuse  quantity  of  pale  urine. 

Employed  hypodermically,  atropia  promptly  checks  sweating.  After 
repeated  experiments  I  find  that  in  profuse  sweating  produced  by  the 
hot  chamber  of  the  Turkish  bath  one  one-hundredth  or  one  two- 
hundredth  of  a  grain  of  atropia  will,  in  a  few  seconds,  completely  dry 
the  skin,  and  maintain  it  dry,  notwithstanding  the  continuance  of  the 
bath.  These  experiments  led  me  to  employ  belladonna  hypodermically 
in  the  sweating  of  phthisis,  and  other  exhausting  diseases,  and  I  found 
that  one  one-hundredth,  or  even  one  two-hundredth  of  a  grain  would 
generally  arrest  the  sweating,  sometimes  for  more  than  one  night ;  and 
that  in  phthisis  it  made  the  patient  sleeja  better,  and  quieted  the  cough. 
Dr.  Murrell  made,  at  my  request,  sixty  experiments  on  phthisical 
patients,  and  he  finds  that  the  drug,  equally  successful  with  men  and 
women  in  febrile  and  non-febrile  cases,  in  the  prostrate  and  compara- 
tively strong  fails  in  about  from  8  to  10  per  cent.  Sometimes  its  effects 
are  delayed :  thus,  if  administered  at  bedtime,  it  may  not  check  sweating 
till  the  following  night  j  or  its  beneficial  influence  may  extend  over 
25 


386  BELLADONNA 

several  nights,  then  gnulually  'wear  off,  so  that  each  night  the  perspira- 
tion returns  a  little  earlier.  In  a  few  cases  it  permanently  checks  the 
sweating. 

This  treatment  unfortunately  produces  disagreeable  dryness  of  the 
throat;  but  as  many  ]}hthisical  patients  suffer  in  this  way,  the  slight 
aggravation  of  the  dryness  is  scarcely  noticeable.  It  may  be  given  as  a 
pill  in  one-fiftieth  to  one-seventieth  of  a  grain. 

Belladonna  checks  the  secretion  of  the  abundant  foul-smelling  sweat 
from  the  feet.  In  making  the  liniment  eau  de  Cologne  may  .be  used 
instead  of  simple  spirit.  We  meet  with  cases  where  the  soles  of  the  feet 
are  very  tender,  and  the  skin  jieels  off  in  large  flakes,  leaving  the  dermis 
very  red.  This  condition  is  accompanied  by  much  sweating  of  the  feet, 
and  is  probably  produced  by  the  sweating.  It  is  apt  to  persist  for  years, 
but  may,  in  some  cases,  be  cured  in  ten  days  or  a  fortnight  by  the  local 
application  of  belladonna  night  and  morning. 

In  checking  sweating  aliout  the  head  and  face  too  much  liniment 
should  not  be  applied  at  one  time,  or,  becoming  absorbed,  it  will  dilate 
the  pupil  and  obscure  the  sight. 

In  the  cases  just  described  it  was  experimentally  joroved  that  the 
effects  are  due  to  the  belladonna  and  not  to  the  spirit. 

Belladonna  checks  salivary  secretion,  and  induces  dryness  of  the 
mouth  and  throat. 

"  The  salivary  glands  are  supplied  by  nerves  derived  from  the 
seventh.  That  part  proceeding  to  the  submaxillary  gland  runs  incor- 
porate with  the  chorda  tympani  nerve.  Through  tliis  nerve  the  sub- 
maxillary gland  is  stimulated  to  secretion.  Thus,  if  an  acid  is  placed 
on  the  tongue,  the  secretion  from  this  gland  becomes  abundant;  but  if 
the  chorda  tympani  nerve  is  divided,  acids  applied  to  the  tongue  or 
mucous  membrane  of  the  mouth,  fail  to  2)roduce  this  secretion.  If  the 
distal  end  is  electrically  stimulated,  we  produce  the  same  effects  as  the 
application  of  an  acid  to  the  mouth ;  thus,  the  arteries  leading  to  the 
submaxillary  gland  enlarge,  and  the  blood  passes  so  quickly  through  the 
gland  that  its  veins  pulsate  and  become  filled  with  arterial  blood,  whilst 
an  abundant  secretion  pours  forth  from  the  gland.  If  atropia  is  given 
to  the  animal,  neither  acids  to  the  mouth  nor  stimulation  of  the  chorda 
tympani  will  excite  submaxillary  secretion.  How  is  this  arrest  produced. 
Does  the  belladonna  prevent  the  flow  of  a  sufficient  supply  of  blood  to 
the  gland  and  so  arrest  secretion  ?  This  view,  formerly  accepted,  is  now 
held  to  be  erroneous,  for  though  atropia  will  diminish  the  blood-supply, 
still,  if  the  chorda  tympani  nerve  is  stimulated,  the  vessels  dilate,  and 
abundant  blood  is  sent  to  the  gland  Avithout  augmenting  the  secretion; 
hence  the  action  of  atropia  is  not  due  to  its  paralyzing  effect  on  the 
vaso-dilator  fibres  of  the  chorda  tympani ;  and  it  is  inferred  that  this 
nerve  also  contains  fibres  distributed  to  tlie  cells  of  the  gland — in  fact, 
secretory  fibres,  and  that  belladonna  paralyzes  these  fibres  of  the  chorda 
tympani. 

"  I  would  jioint  out  that  atropia  may  possibly  act  directly  on  the 
gland  cell,  this  hypothesis  explaining  the  foregoing  facts  as  satisfactorily 
as  does  the  assumj^tion  of  the  existence  of  secretory  fibres. 

"  Experiments  indicate  the  existence  of  sweat  centres.  Luchsinger 
believes  that  these  centres  are  situated  in  the  lumbar  and  lower  part  of 
the  dorsal  region  of  the  spinal  cord.     Xawrocki  believes  that  the  medulla 


1 


EELLADONNA.  387 

contains  a  sweat  centre.  It  has  been  demonstrated  by  Lnchsinger  and 
Ostramoff  that  the  sweat  fibres  run  witli  the  vaso-motor  fibres.  Lnch- 
singer and  JSTawrocki  sliow  tliat  pilocarpine  and  atropia  affect  the 
sweat  by  tlieir  action  on  the  peripliery  of  the  sweat  apparatus,  and 
perhaj^s  in  tlie  centre  as  well.  Dr.  Ott  and  Mr.  W.  Field  also  show  that 
niuscarin  also  excites  sweating  by  its  action  on  the  peripheral  sweat  aji- 
l^aratus. 

"  Belladonna,  as  we  have  seen,  affects  the  salivary  secretion  by  its 
action  on  the  peripheral  part  of  the  secretory  nerves,  and  now  it  is 
true  that  belladonna,  i^ilocarpine,  and  muscarin  act  on  the  same  part  of 
the  sweat  nerves." 

Dr.  Cook  has  recently  reported  cases  of  salivation  from  mercury  and 
scurvy,  cured  by  the  hypodermic  injection  of  atropia. 

Eecollecting  that  in  acne  there  is  over-abundant  secretion  from  the 
sebaceous  follicle,  I  was  induced  to  use  belladonna  with  the  hope  of 
checking  it,  and  indeed  this  treatment  seemed  to  be  of  some  slight 
service. 

Whilst  speaking  of  milk  abscesses  it  was  stated  that,  apart  from  its 
milk-arresting  power,  belladonna  will  in  some  measure  subdue  inflam- 
mation and  its  accompanying  pain.  Belladonna,  too,  is  effectual  in 
other  forms  of  inflammation  which  threaten  to  end  in  abscess.  Mr. 
Christopher  Heath  has  shown  that  belladonna  will  prevent  the  forma- 
tiqn  of  abscesses  in  the  neck  and  elsewhere,  and  after  the  onset  of  sup- 
jjuration  wall  check  pain  and  inflammation. 

The  belladonna  treatment  of  boils  and  carbuncles  often  succeeds. 
(See  Sulphides  and  Poultices.) 

Belladonna  preparations  are  of  further  use  as  local  apj)lications. 
Thus,  the  extract  smeared  over  the  painful  cracks  in  the  mucous  mem- 
brane is  employed  to  relieve  the  pain  of  fissure  of  the  anus. 

The  extract  in  conjunction  with  tannin,  in  the  proportion  of  one  or 
two  grains  of  extract  to  six  or  eight  of  tannin,  is  recommended  by 
Trousseau  in  leucorrhcea  with  ulceration  of  the  os  uteri,  and  in  neuralgia 
of  the  uterus.  The  belladonna  arrests  the  too  abundant  secretion  from 
the  mucous  glands,  while  its  action  in  this  respect  is  assisted  by  the 
tannin.  In  both  affections  belladonna  is  serviceable  in  relieving  pain. 
The  mixture  of  belladonna  and  tannin  may  be  wrapped  in  cotton-wool, 
or  made  into  a  bolus  with  cocoar^nut  fat,  and  placed  in  contact  vsdth  the 
painful  and  over-secreting  os.  Some  obstinate  forms  of  leucorrhoea 
yield  completely  to  this  treatment. 

When  the  disease  depends  on  too  free  a  secretion  of  the  mucous 
glands  about  the  os  uteri,  and  when  this  condition  is  associated  with 
much  pain,  the  following  injection  yields  good  results: — bicarbonate  of 
soda,  a  drachm;  tincture  of  belladonna,  two  ounces;  water,  a  pint.  The 
S3'ringe  should  be  introduced  as  far  as  possible,  while  the  j)atient  lies 
on  her  back,  with  her  buttocks  raised  by  a  jiillow,  while  one  or  two 
syringefuls,  used  cold,  should  be  injected  into  the  vagina,  and  made  to 
reach  the  mouth  of  the  uterus.  The  position  should  be  maintained  for 
a  few  minutes,  so  as  to  allow  the  wash  to  remain  in  contact  with  the  os 
uteri. 

Dropped  into  the  eye,  applied  to  the  surrounding  skin,  or  introduced 
into  the  stomach,  preparations  of  belladonna  very  speedily  produce  ex- 
treme dilatation  of  the  pupil.    This  dilatation  is  one  of  the  most  character- 


388  BELLADONNA. 

istic  symptoms  of  belladonna.  In  iritis,  and  some  other  e3'e  diseases, 
solutions  of  atropia  are  used  to  produce  dilatation  of  the  pupil,  and  to  pre- 
pare the  eye  for  ophthalmoscopic  examination.  In  conjunctivitis,  and 
other  inflammations  of  the  eye,  belladonna  is  employed  both  locally  and 
internallv. 

The  local  application  of  the  liniment  or  ointment  of  belladonna  will 
often  relieve,  and  sometimes  even  cure,  neuralgia.  Its  efficacy  is  most 
manifest  on  the  fifth  nerve,  as  in  neuralgia  of  the  brow,  or  under  the 
eye,  accompanied  by  severe  pains  in  the  eyeball,  and  intolerance  of  light. 
Even  sciatica  will  sometimes  succumb  to  it. 

A  full  dose  of  belladonna  produces  great  dryness  of  the  tongue  and 
roof  of  the  mouth,  extending  down  the  pharynx  and  larynx,  inducing, 
consequently,  some  difficulty  ni  swallowing,  together  Avith  hoarseness,  and 
even  drv  cough;  a  large  dose  will  sometimes  induce  dryness  of  the 
Schneiderian  membrane,  and  dryness  and  much  injection  of  the  conjunc- 
tiva. 

"After  about  two  hours,"'  says  Dr.  J.  Ilarley,  "the  dryness  of  the 
mouth  gives  way,  to  be  replaced  by  a  viscid,  sticky,  acid,  and  foul-smell- 
ing secretion,  and  the  mucous  membrane  becomes  clammy,  and  the  tongue 
is  covered  with  a  Avhite  fur."  Ilarley  produced  ophthalmia  in  a  dog  by 
belladonna.  Several  of  these  symptoms  indicate  the  influence  of  bella- 
donna in  arresting  secretion. 

In  several  instances  Ilarley  has  known  belladonna  to  cleanse  and  moisten 
the  tongue  of  typhus-fever  patients.  Belladonna  is  employed  in  several 
hiflamnuitory  diseases  of  the  throat,  and  its  good  effects  are  most  apparent 
when  the  throat  and  tonsils  are  acutely  inflamed  and  swollen.  It  may 
be  given  in  combination  with  aconite,  but  the  influence  of  aconite  on  this 
form  of  inflamed  throat,  provided  the  pulse  is  full,  and  the  skin  hot  and 
dry,  exceeds  that  of  belladonna. 

Tlie  influence  of  belladonna  on  digestion  is  not  known. 

It  is  not  j^et  satisfactorily  ascertained  in  what  Avay  belladonna  affects 
the  intestines;  but,  bearing  in  mind  its  influence  on  the  lining  membrane 
of  the  mouth,  it  may  be  conjectured  that  belladonna  lessens  the  secretion 
of  the  intestinal  canal.  It  has  been  asserted  that  belladonna  increases 
the  peristaltic  movement  of  this  canal,  but  others  insist  that  whether  given 
in  small  or  large  doses,  belladonna  weakens  the  peristaltic  actions. 
Others  assert  that  in  small  doses  it  increases  peristaltis,  but  in  large  doses 
paralyzes  the  muscular  tissues  of  the  intestine,  and,  indeed,  maintain 
that  iDelladonna  affects  all  unstriped  muscular  fibre  in  a  twofold  Avay.  It 
has  been  experimentally  proved  that  it  paralyzes  the  terminations  of  the 
inhibitory  fibres  of  the  splanclmics  distributed  to  the  intestines;  thus  stimu- 
lation of  the  splanchnics  will  stop  intestinal  movement,  but  small  doses 
of  atropia  will  ])revent  this  arrest. 

Trousseau  recommended  belladonna  in  obstinate  constipation,  and  no 
doubt,  in  many  instances,  it  succeeds  admirably.  He  advised  doses  of 
from  one-sixth  to  one-fourth  of  a  grain  of  the  extract  to  be  taken  once  a 
day,  either  night  or  morning,  gradually  increasing  the  dose  and  diminish- 
ing or  discontinuing  the  medicine  when  the  constipation  is  removed.  Dr. 
Nunneley  finds  this  treatment  useful  in  all  forms  of  constipation,  espe- 
cially when  co-existing  with  dyspepsia,  characterized  by  a  tliinly-furred 
tongue,  with  prominent  red  papilla?  at  the  tip,  epigastric  tenderness,  pain 
after  food,  and  often  more  or  less  headache.  It  ensures  a  natural  evacu- 
ation daily.     It  must  be  continued  a  fortnight  or  three  weeks.     The  late 


BELLADONNA.  389 

Mr,  Foster,  of  Tluntingdon,  employed  a  small  dose  of  belladonna  to  pre- 
vent the  constipating  effects  of  iron.  In  some  of  the  severest  cases  of 
constipation  where  jwwerful  purgatives  have  failed,  a  suppository  of  one 
or  two  grains  of  the  extract  has  opened  the  bowels. 

Belladonna  often  relieves  colic  of  the  intestines,  and  is  especially  ser- 
viceable in  colic  of  children. 

That  the  active  principle  of  belladonna  is  readily  absorbed  into  the 
blood  is  proved  by  the  symptoms.  After  a  considerable  dose  of  belladonna, 
the  face  becomes  much  flushed;  the  eye  bright,  dry  and  injected;  the 
pupil  dilated;  the  sight  dim  and  hazy;  while  the  power  of  accommodation 
in  the  eye,  for  instance,  is  lost.  The  mind  and  senses  are  peculiarly 
affected.  The  ideas,  at  first  rapid  and  connected,  become  incoherent  and 
extravagant,  and  there  is  often  decided  delirium,  with  pleasing  illusions. 
Sometimes  the  patient  is  seized  with  restlessness,  keeps  continually  mov- 
ing, and  cannot  be  quieted.  A  kind  of  somnambulism  is  occasionally 
observed;  cases  are  recorded  where,  under  the  influence  of  belladonna, 
the  patient  for  a  long  time  performs  the  movements  customary  to  his 
occupation,  and  it  is  narrated  of  a  tailor  that  he  sat  for  hours  moving  his 
hands  and  arms  as  if  sewing,  and  his  lips  as  if  talking. 

The  delirium  maybe  furious  and  dangerous,  requiring  restraint;  nay, 
it  is  recorded  of  a  man  poisoned  by  this  drug,  tbat  so  violent  did  he  become 
that  he  was  ordered  to  be  confined  in  a  mad-house.  Sometimes  a  very 
small  dose  will  induce  mental  disturbance,  and  so  great  is  the  suscepti- 
bility of  some  people  that  even  when  applied  to  the  skin  in  the  form  of 
plaster  or  ointment,  belladonna  induces  marked  cerebral  disorder. 

It  is  evident,  then,  that  belladonna  affects  the  cerebrum.  Alberton 
has  experimentally  proved,  however,  that  it  has  no  influence  on  the  motor 
centres. 

Belladonna  weakens  the  muscular  power,  renders  the  gait  ixnsteady 
and  staggering,  so  that  a  patient,  having  lost  control  over  his  movements, 
may  run  against  objects  he  sees,  yet  desires  to  avoid. 

This  loss  of  power  is  due  not  to  the  action  on  the  muscles,  but  to  the 
action  of  atropia  on  the  motor  nerves;  for  atropia  paralyzes  both  the  ter- 
minations and  the  trunks  of  motor  nerves. 

Some  experiments  I  made  with  the  assistance  of  Dr.  Murrell  convince 
us  that  some  of  this  paralysis  is  due  to  the  depressing  effect  of  atropia  on 
the  spinal  cord. 

Atropia  affects  the  cord  and  excites  tetanus,  an  effect  long  undetected, 
till  it  was  pointed  out  by  Dr.  Fraser. 

Dr.  Fraser  has  shown  (1)  that  in  frogs  tetanic  sj^mptoms  follow  the  subcutaneous 
injection  of  a  dose  of  sulphate  of  atropia  equivalent  to  about  l.OOOth  of  the  weight  of 
the  animal;  {2}  that  this  tetanus  sometimes  sets  in  on  the  second  day,  but  more  fre- 
quently on  the  third,  fourth,  or  tifth;  (8  )  that  it  varies  in  its  duration  from  a  few 
hours  to  seventeen  days;  (4)  that  it  is  due  to  the  action  of  the  drug  on  the  cord  {medulla, 
oblongata   and  medulla  spinaUn). 

In  conjunction  with  Mr.  JMurrell  I  have  made  some  experiments  on  the  subject. 
Our  observations  were  made  during  the  months  of  May,  June,  and  July.  The  frogs 
used  for  the  e.xperiments  were,  with  a  few  exceptions,  the  ordinary  liaua  iemporaria. 
We  employed,  except  when  the  contrary  is  stated,  a  1  in  20  solution  of  sulphate  of 
atropia  in  water,  the  requisite  dose  being  injected  either  under  the  skin  of  the  back, 
or  into  the  axilla.  The  first  twelve  cast's  were  observed  thrice  daily,  l)etween  seven 
and  eight  in  the  morning,  one  and  two  in  the  afternoon,  and  live  and  six  in  the  even- 
ing. In  the  sul)se(pient  experiments  observations  were  made  much  more  frequently, 
with  the  view  of  determining  how  rapidly  pai'alysis  occurred,  how  soon  it  reached  its 
height,  and  how  (luickly  it  declined.  In  .some  cases  the  animal  was  under  almost  con- 
tinuous observation  for  many  hours,  in  others  the  notes  were  taken  every  eight  or  ten 


390  BELLADONNA. 

miinites  for  the  first  liour,  and  liourly  for  ever  tliree  hours  subsequently.  We  may 
take  this  opportunity  of  explainmg  that  whenever  we  employ  the  term  "  pithed  and 
pegged  "  we  mean  division  of  the  eord  1)}'  cut  ting,  and  destruetion  of  the  brain  by  the 
introduction  of  a  piece  of  wood  into  the  cranial  ca\ity.  Like  Dr.  Fraser,  we  often  oi)- 
tained  strong  tetanus  from  the  subcutaneous  injection  of  atropia,  but  found  that  his 
dose  (from  ^^^  to  xsVtt  oi  the  weight  of  the  frog)  usually  killed  our  animals  instead  of 
producing  the  desired  result.  With  a  smaller  dose,  however,  namely,  from  yg^jj  to 
^TyW'  ^^"^  were  more  successful.  In  our  experiments  the  tetanus  commenced  earlier 
than  In  Dr.  Eraser's,  our  average  period  of  onset  being  20  hours;  in  one  case  it  was 
w-ell  marked  in  3  hours,  whilst  in  the  longest  it  was  delayed  28  hours.  With  us,  too,  it 
lasted  for  a  shorter  time,  for  in  one  animal  it  continued  only  eight  hours,  and  never,  in 
any  instance,  exceeded  live  days.  We  imagine  that  these  differences  are  due  to  the 
time  of  the  year  at  which  the  observations  were  made. 

Why  is  the  tetanus  so  long  delayed  after  atropia  poisoning  ?  One  writer  referring 
to  Dr.  Fraser's  paper  says  that  the  paralysis  of  the  motor  nerves  prevents  the  tetanic 
condition  of  the  cord  from  displaying  itself  on  the  muscles,  but  Dr.  Fraser  himself 
nowhere  makes  this  assertion,  and,  indeed,  his  cases  prove  the  contrary. 

This  proffered  explanation  we  hold  to  be  erroneous,  for  the  following  reasons:  — 

I.  Bezold  and  Bla>baum  have  shown  tliat  even  with  very  large  doses  it  is  ditlicult 
to  destroy  completely  the  conducting  power  of  the  motor  nerves,  and  it  is  obvious  that 
as  long  as  their  conductivity  is,  in  the  smallest  degree,  retained,  the  tetanic  condition 
of  the  cord  must  produce  more  or  less  tetanus  of  the  nmscles. 

IL  The  onset  of  tetanus  is  delayed  even  in  cases  in  which  the  dose  of  atropia  is  so 
small  as  to  produce  but  slight  paralj^sis,  and  it  must  be  admitted  that  if  the  motor 
nerves  are  capable  of  conveying  voluntary  and  normal  reflex  impressions  they  can 
conduct  tetanic  reflex  stimuli.  Thus,  in  many  of  Fraser's  cases,  there  was  never  com- 
plete loss  of  reflex  and  voluntary  power  during  the  period  which  elapsed  between  the 
injection  of  the  drug,  and  the  onset  of  tetanus.  It  will  be  found  that,  of  the  cases  in 
wiiich  he  obtained  tetanus,  there  were  twelve  in  which  the  paralysis  was  incomplete; 
that  in  seven  of  the  thirteen  in  which  it  had  been  complete  a  partial  recovery  of  reflex 
and  voluntary  power  had  taken  place  for  a  day  or  more  before  the  onset  of  tetanus. 
In  eleven  of  our  own  twenty-six  cases  there  was  incomplete  paralysis  of  reflex  action 
and  voluntary  power,  and  in  all  these  cases  the  onset  of  tetanus  was  delaj'ed.  In  two 
cases,  indeed,  both  voluntary  and  reflex  power  had  been  completely  regained  before 
tetanus  set  in.  In  one  case  in  which  there  had  Iteen  complete  paralysis  it  began  to 
impi'ove  five  and  a  half  hours  before  the  commencement  of  tetanus. 

III.  If  the  poison  be  prevented  from  having  access  to  certain  limited  regions  by 
ligature  of  the  nutrient  vessels  the  onset  of  tetanus  is  still  delayed  even  in  these  pro- 
tected parts.  Fraser  gives  an  account  of  four  experiments,  in  which  he  adopted  this 
mode  of  procedure.  In  three,  before  poisoning  the  animal,  he  tied  the  femoral 
vessels,  and  in  one  the  abdominal  aorta,  and  yet  tetanus  did  not  occur  in  the  protected 
limbs  till  twenty-two  hours,  fifty-one  hours,  three  days,  and  twenty-t^vo  hours  respec- 
tively. 

We  have  tested  the  action  of  atro]3ia  on  ten  pithed  and  pegged  frogs,  in  which 
before  poisoning  the  abdominal  aorta  had  Ijeen  tied.  The  following  was  our  mode  of 
procedure: — We  first  divided  the  medulla  In^  cutting  through  the  occipito-atlantal 
membrane,  and  then  passed  a  pointed  wooden  peg  upwards  through  tlie  foramen 
magnum  into  the  skull,  so  as  to  destroy  the  brain,  and  then  tied  the  abdominal  aorta 
just  above  its  bifurcation.  In  three  cases  in  which  we  obtained  tetanus  it  was  delayed 
for  twenty-five,  nine,  and  four  and  a  half  hours  respectively. 

We  conclude  then,  for  these  reasons,  that  the  late  occurrence  of  tetanus  in  atropia 
poisoning  is  not  due  to  paralj'sis  of  the  motor  nerves,  but  that  it  is  owing  to  the  cord 
being  slowly  affected.  It  appears  that  whilst  the  poison  quickly  paralyzes  it  takes 
many  hours,  or  even  days,  before  it  tetanizes. 

It  lias  been  suggested  that  this  delayed  tetanus,  which  often  sets  in 
from  the  third  to  the  fifth  day,  cannot  be  directly  due  to  the  atropia,  but 
must  depend  on  some  j)roducts  slowly  formed  in  the  body  by  the  atropia. 

This  explanation  appears  to  me  to  be  wrong,  for  the  following  reason: — Atropia 
corresponds  to  other  tetanizers,  and  conforms  to  Fraser's  law  tliat  when  alkaloids  pro- 
ducing tetanus  are  converted  into  ethyl  or  methyl  compounds  they  lose  tlieir  jiower  of 
exciting  tetanus,  and  paralyze  the  enils  of  tiie  motor  nerves.  Ethyl-atropium  does  not 
tetanize,  but  is  a  powerful  paralyzer  of  the  motor  nerves,  far  more  so  than  atropia  itself. 

The  afferent  nerves  are  unaffected,  or  but  little  affected  by  atropia. 


BELLADONIS-A. 


391 


Most  observers  state  that  atropia  produces  severe  pain  in  the  head, 
generally  over  the  forehead,  and  in  the  eyes,  and  sometimes  the  top  of  the 
head.  Singing  in  the  ears  also  occurs,  with  more  or  less  giddiness.  In 
persons  poisoned  h}^  this  plant  spasmodic  contraction  of  the  sphincter  of 
the  bladder  has  been  not  unfrequently  observed,  and  a  scarlet  rash  often 
breaks  out  on  the  skin,  a  rash  said  to  be  like  that  of  scarlet  fever,  and  to 
be  most  marked  in  the  neighborhood  of  the  Joints.  jMr.  J.  G.  Wilson  re- 
ports a  case  in  Avhich  the  local  application  of  belladonna  produced  a  gen- 
eral red  rash,  with  redness  of  the  throat  and  dilated  pupils. 

The  first  effect  of  belladonna  on  the  pulse  is  to  increase  its  frequency, 
fullness,  and  force,  to  the  extoit  even  of  fifty  to  sixty  beats  in  the  minute, 
moderate  doses  at  the  same  time  increasing  the  blood  pressure.  This 
condition  of  the  circulation  continues  till  the  tongue  and  mouth  become 
moist  and  -clammy,  when  the  pulse  diminishes  in  frequency,  and  loses 
strength.  (J.  Harley.)  In  fatal  cases  the  pulse  grows  rapid,  intermittent 
and  weak.  Dr.  J.  Harley  considers  belladonna  a  powerful  lieart  tonic, 
and  he  points  out  how  it  serves  to  reduce  the  frequency  and  to  strengthen 
the  beats  of  the  heart  when  Aveakened  by  disease. 

Atro])ia  paralyzes  the  terminations  of  the  vagi,  for  in  animals 
poisoned  by  atropia  neither  section  nor  galvanization  of  the  vagi  affects 
the  heart.  When  injected  into  the  carotid,  so  as  to  reach  the  central  ner- 
vous system  before  the  nerves,  atropia  first  reduces  the  number  of  the 
heart's  beats,  showing  that  it  stimulates  the  nucleus,  whilst  it  paralyzes 
the  termination  of  the  vagi. 

Atropia  paralyzes  an  intracardiac  inhibitoiy  apparatus.  Thus,  after  poisoning' 
by  curare,  stimulation  of  the  vagi  has  no  effect  on  tlie  heart,  but,  on  the  applica- 
tion of  the  electrodes  to  the  sinus  the  lieart  is  at  once  arrested.  Curare  paral3'zes 
the  terminations  of  the  vagi,  but  leaves  unaffected  an  inhibitory  apparatus  in  the 
heart  itself.  After  poisoning  by  atropia,  neither  stimulation  of  the  vagi  nor  of 
the  sinns  affects  the  heart,  whence  it  is  concluded  that  atropia  paralyzes  the  in- 
tracardiac inhibitory  apparatus. 

Atropia  is  considered  to  stimulate  the  cardiac  accelerator  nerve. 

Both  reasoning  and  expermientation  led  Mr.  Schiifer,  Professor  of 
Physiology  at  University  College,  to  recommend  the  use  of  atropia  during 
the"^  inhalation  of  chloroform.  The  chief  source  of  danger  during  the 
use  of  chloroform  is  its  depressing  action  on  the  heart,  the  heart,  in  many 
fatal  cases,  suddenly  ceasing  to  beat.  This  action,  Mr.  Schiifer  believes, 
is  due  to  the  chloroform  stimulating  the  inhibitory  cardiac  apparatus. 
No  doubt,  too,  some  of  the  cases  of  sudden  death  are  due  to  the  effect  of 
the  operation  on  the  nervous  system.  Thus,  it  is  well  known,  that  when 
the  leg  of  a  frog  is  crushed,  the  heart  stops,  but  division  of  the  vagi  j3re- 
vents  this  stoppage.  Now  Schiifer  argues  that  a  dose  of  atropia,  sufficient 
to  quicken  the  pulse,  i.e.,  to  paralyze  the  inhibitory  cardiac  apparatus,  will 
prevent  chloroform  stopping  the  heart,  and  its  arrest  through  shock. 

Dr.  Xtinneley  asserts  that  in  the  frog  belladonna  neither  increases 
the  frequency  of  the  heart's  beats  nor  dilates  the  pupil,  and  this  state- 
ment has  been  abundantly  corroborated  in  respect  to  its  action  on  the 
heart,  showing  that  belladonna  must  affect  the  frog  otherwise  than  man 
and  some  other  animals,  as  the  dog,  the  horse,  etc. 

Luchsinger  finds  atropia  paralyzes  smooth  muscular  fibre,  but  not 
striped  muscular  fibre;  hence  it  does  not  affect  the  striped  muscular 
fibres  of  the  irides  of  birds  and  reptiles. 

Atropia  in  moderate  doses  heightens  arterial  pressure,  probably  l)y 


392  BELLADOISTNA. 

its  influence  on  the  vaso-motor  centre.  Under  large  doses  arterial  pres- 
sure falls,  from  direct  paralysis  of  the  muscular  coat  of  the  blood-vessels. 

The  action  of  belladonna  on  the  pupil  has  been  variously  explained, 
some  believing  that  it  depends  on  paralysis  of  the  third  nerve  supplying 
the  iris;  some  teaching  that  it  is  due  to  excitation  of  the  sympathetic; 
others  maintaining  that  belladonna  produces  the  dilatation  by  preventing 
turgescence  of  the  vessels  of  the  iris.  From  a  survey  of  the  numerous 
observations  of  various  experimenters.  Dr.  H.  Wood,  in  his  able  and  valu- 
able work,  concludes  that  atropia,  applied  locally,  causes  mydriasis  by 
paralvzing  the  peripheral  ends  of  the  oculo-motor  nerve,  probably  by 
stimulating  the  peripheral  ends  of  the  sympathetic.  Given  internally, 
atropia  almost  certainly  causes  mydriasis,  not  indirectly  by  influencing 
the  nerve-centres,  but  by  being  carried  in  the  blood  to  the  eye  itself,  and 
there  acting  precisely  as  if  applied  locally. 

To  briefly  sum  up  the  action  of  atropia,  we  find: 

1.  It  tetanizes  the  cord  and  heightens  its  reflex  function. 

2.  It  stimulates  the  respiratory  centre  and  the  inhibitory  centre  of  the 
heart. 

3.  It  stimulates  the  cardiac  accelerator  nerve  or  its  centre. 

4.  It  stimulates  the  vaso-motor  centre  and  so  heightens  arterial  pres- 
sure. 

5.  It  paralyzes  the  motor  nerves,  first  affecting  the  trunk. 

6.  It  paralyzes  the  termination  of  the  vagi,  both  in  the  heart  and 
lungs. 

7.  It  paralyzes  the  terminations  of  the  secretory  nerves  of  the  salivary 
glands,  and  those  of  the  sweat  glands. 

8.  It  paralyzes  the  terminations  of  the  inhibitory  fibres  of  the  splanch- 
nics. 

9.  Large  doses  slightly  depress  the  functions  of  the  afferent  nerves. 

10.  It  paralyzes  the  termination  of  the  oculo-motor  nerves,  and  stimu- 
lates the  sympathetic,  so  far  as  the  iris  itself  is  concerned. 

It  appears,  then,  that  whilst  to  a  large  part  of  the  central  nervous  system 
it  acts  as  a  "  stimulant,"  to  many  of  the  nerves  it  operates  as  a  paralyzer. 

The  influence  of  belladonna  on  the  sympathetic  led  Dr.  E.  T.  Smith 
to  employ  it  in  two  cases  of  exophthalmic  goitre — a  disease  regarded  by 
some  as  due  to  paralysis  of  the  sympathetic  of  the  neck.  The  effects  were 
striking.  Five  minims  of  the  tincture  hourly  afforded  great  relief  in 
four  or  five  days,  though  the  disease  had  lasted  more  than  a  year.  In 
tAvo  months  the  exophthalmos  had  much  lessened.  Homoeopathic  doctors 
have  long  employed  this  treatment. 

Belladonna  is  often  used  to  relieve  pain.  Dr.  Anstie  considers  it  the 
best  remedy  to  mitigate  every  kind  of  pain  in  the  pelvic  viscera.  Some 
neuralgias,  no  doubt,  yield  to  this  medicine,  and  it  appears  to  jjossess  most 
efficacy  over  neuralgia  referable  to  the  fifth  nerve.  Cases  are  recorded  of 
relief  afforded  by  it  in  sciatica. 

Trousseau  recommended  the  following  method  of  treating  neuralgia: — 
To  administer  one-fifth  part  of  a  grain  every  hour  till  giddiness  is  jiro- 
duced,  and  then  to  lessen  the  dose;  but  to  continue  the  medicine  for 
several  days. 

Trousseau  also  employed  belladonna  successfully  in  epilepsy,  according 
to  the  following  method: — "During  the  first  month  of  treatment  the 
patient  takes  a  pill,  composed  of  extract  of  belladonna  and  powdered  leaves 
of  belladonna,  each  one-fifth  part  of  a  grain  every  day,  if  his  attacks  occur 


I 


BELLADONNA,  6\)A 

chiefly  in  the  daytime;  or  in  the  evening  if  tliey  are  cliiefly  nocturnal. 
One  pill  is  added  to  the  dose  every  month,  and,  whatever  be  the  dose,  it 
is  always  taken  at  the  same  period  of  the  day.  By  this  means  the  patient 
may  reach  the  dose  of  from  five  to  twenty  pills,  and  even  more."  The 
dose  is  to  l)e  regulated  by  circumstances.  This  treatment,  it  is  said,  even 
when  it  fails  to  cure,  yields  much  relief. 

Belladonna  often  allays  both  the  cough  and  oppressed  breathing  of 
asthma.  To  ensure  success  it  must  be  employed  in  considerable  doses, 
as  Dr.  H.  Salter  pointed  out,  and  I  have  often  verified  his  observation. 
Ten  minims 'of  the  tincture  every  two  or  three  hours,  a  quantity  gener- 
ally well  borne,  is  often  sufficient;  but,  if  any  of  the  undesired  symptoms 
of  belladonna  set  in,  the  dose  must  be  reduced.  If  the  patient  is  not  very 
susceptible  to  the  action  of  the  drug,  far  larger  doses  are  sometimes 
reqiiired.  Thus,  occasionally  half  a  drachm  of  tlie  tincture  hourly  is  well 
and  advantageously  borne.  Such  a  dose  need  only  to  be  taken  at  the 
time  of  the  paroxysm;  but  when  this  lasts  several  days,  the  medicine 
should  be  given  in  the  quantity  recommended  till  an  impression  is  made 
on  the  disease.  The  effect  is  chiefly  satisfactory  in  either  averting  the 
attack  or  rendering  it  milder. 

Belladonna  is  one  of  the  best  remedies  for  whooping  cough;  but  as 
in  asthma,  to  obtain  any  good  from  it,  it  must  be  employed  in  coiisider- 
able  doses.  To  children  two  and  three  years  old  I  often  give  as  much  as 
ten  minims  of  the  tincture  every  hour,  and  this  quantity  usually  produces 
no  efi'ect,  except  on  the  cough,  neither  dilating  the  pupil,  nor,  so  far  as 
one  can  judge  in  children  so  young,  making  the  throat  dry;  and  it  cer- 
tainly does  not  in  chikh-en  a  little  older,  who  are  able  to  express  their 
feelings. 

Should  drowsiness,  delirium  or  dilatation  of  the  pupil  occur,  of  course  the 
dose  must  be  diminished.  The  only  symptoms  I  have  witnessed  from  these 
large  doses  is  dilatation  of  the  pupil.  Children,  it  is  well  known,  bear 
belladonna  much  better  than  adults;  hence  the  slight  effect  of  so  large  a 
dose,  and  the  small  influence  which  a  less  quantity  exerts  on  whoopiug 
cough — a  disease  of  childhood.  Some  writers  state  that  children  become 
rapidly  accustomed  to  belladonna.  These  large  doses,  however,  may  be 
given  at  first,  and  in  the  course  of  many  cases  1  have  never  had  to  give 
less  on  account  of  any  toxic  effects.  These  doses  often  much  reduce  the 
severity  and  frequency  of  the  cough,  even  during  the  period  when  it  is 
most  violent  ancl  convulsive.  But,  like  all  other  remedies  in  this  disease, 
belladonna  is  of  little  use  if  the  child  is  exposed  to  cold  afld  cutting  winds. 
If  the  weather  is  cold  the  child  should  be  confined  to  the  house  in  a  warm 
room;  if  the  weather  is  mild,  out-door  exercise  is,  of  course,  highly  bene- 
ficial ;  but  cold  must  be  most  carefully  avoided. 

AVhile  there  can  be  no  reasonable  doubt  of  the  great  efficacy  of  bella- 
donna in  many  cases  of  whooping  cough,  it  must  be  admitted  that  in 
many  instances,  without  apparent  reason,  it  fails.  Influences,  at  present 
not  understood,  appear  to  modify  its  effects;  for  in  some  epidemics  it  is 
very  successful,  while  in  others  it  appears  to  be  inoperative.  Belladonna 
exerts  but  little  effect  on  whooping  cough  when  bronchitis  or  any  irrita- 
tion exists,  as  that  from  teetbiug,  worms,  etc.  If  the  gums  are  red, 
swollen,  and  painful,  they  must  be  freely  lanced,  and  other  sources  of 
irritation  removed.  Belladonna  is  considered  of  special  use  in  the  third 
week  of  the  attack — at  a  time,  that  is,  Avhen  the  febrile  stage  has  passed 
away,  and  the  violence  of  the  convulsive  attacks  is  declining. 


394  BELLADONNA. 

Belladonna  is  often  useful  in  other  coughs,  although  with  our  limited 
knowledge  on  this  subject  it  is  impossible  to  lay  down  precise  rules  for  its 
employment. 

It  is  often  useful  in  certain  forms  of  headache — for  instance,  when  the 
pain  is  situated  over  the  brows  and  in  the  eye-balls,  which  seem  as  if  too 
large  for  the  head,  and  as  if  they  would  be  forced  out  of  the  skull.  These 
headaches  are  not  due  to  stomach  or  uterine  derangement,  indeed,  very 
often  their  cause  cannot  be  discovered.  They  are  especially  peculiar  to 
youns:  women,  and  they  seem  due  to  weakness  and  over  work.  Three 
minims  of  the  tincture  should  be  given  everv  three  hours. 

It  is  said  that  belladonna  controls  the  delirium  of  fevers — as  of  typhus 
fever. 

Dr.  John  Harley  finds  belladonna  useful  in  typhus  fever.  It  slows  and 
strengthens  the  pulse,  reduces  temperature,  moistens  the  tongue,  and  he 
thinks  shortens  the  course  of  the  disease.  Its  prolonged  use  makes  the 
heart  irritable. 

Belladonna  is  both  speedier  and  more  certain  than  any  other  remedy  in 
removing  that  troublesome  affection,  incontinence  of  urine.  It  must  be 
given  in  doses  of  from  ten,  twenty,  to  thirty  drops  of  the  tincture  three 
times  a  day;  small  doses  often  fail  when  large  ones  at  once  succeed.  It 
may  take  a  fortnight  to  succeed.  Sometimes  the  incontinence  is  not 
limited  to  the  night,  but  may  trouble  children  during  the  day.  These 
severe  forms  will  often  yield  to  belladonna;  but  while  in  some  cases  it  is 
thus  effectual,  still  it  often  fails  altogether,  although  no  worms  infest 
the  intestines,  no  irritation  exists  about  the  rectum,  and  no  reason  seems 
to  exist  to  account  for  its  failure.  Strychnia,  cantharides,  turpentine, 
santonin,  or  galvanism,  should  then  be  tried.  In  nocturnal  inconti- 
nence the  child  should  drink  but  little  some  hours  before  going  to  bed,  and 
he  should  be  waked  in  the  middle  of  the  night  to  pass  water. 

It  sometimes  checks  the  incontinence  of  urine  of  the  old  or  paralvtic. 

Belladonna,  used  internally  or  externally,  is  certainly  efficacious  in 
erysipelatous  inflammation.  It  may  be  given  in  combination  with  aconite; 
but  when  the  skin  is  hot  and  pungent,  and  the  pulse  is  firm  and  resistant, 
aconite  exeits  over  this  inflammation  an  influence  far  more  potent  than 
that  of  belladonna. 

Belladonna  has  been  recommended  as  a  preventive  of  scarlet  fever,  but 
so  much  prejudice  has  been  introduced  into  the  discussion  of  this  question 
that  it  is  difficult  to  conclude  Avhether  it  has  any  prophylactic  virtue. 

Belladonna  has  been  found  of  service  in  the  treatment  of  seminal 
emissions;  a  grain  aiid  a  half  of  sulphate  of  zinc  with  a  quarter  of  a  grain 
of  extract  of  belladonna,  three  or  four  times  a  day,  is  often  a  successful 
remedy  in  cases  of  nocturnal  emissions. 

Atropia  is  antagonistic  to  opium.  Calabar  bean,  muscarin,  jaborandi, 
bromal,  aconite,  and  prussic  acid. 

As  belladonna  and  opium  are  in  some  respects  reciprocally  opposed  in 
their  action,  as  on  the  eye,  etc.,  it  has  been  assumed  that  they  must  Ije 
opposed  in  every  particular,  and  that  one  is  as  an  antidote  to  the  other. 
Many  cases  are  adduced  of  opium  poisoning,  where  the  symptoms,  although 
very  serious,  were  apparently  removed  by  belladonna,  and  vice  versa.  Dr. 
Erlenmeyer  is  of  o})inion  that,  in  respect  to  their  action  on  the  brain, 
these  agents  are  antagonistic,  and  that  nc  'joma  will  result  when  they  are 
administered  conjointly;  but  they  exercise  no  miitual  counteractive  influ- 
ence on  the  sensory  nerves,  and  hence  he  recommends  them  in  combina- 


BELLADONNA.  395 

tion  to  relieve  pain.  On  the  other  liaiul,  some  authorities,  anionic  whom 
maybe  named  Brown-Sequard  and  J.  Harley,  dispute  this  antagonism,  on 
the  ground  that  tlie  cited  cases  are  insufhcient  to  prove  it;  and  it  has  not 
been  observed  in  experiments  on  the  lower  animals  and  on  man.  It  must 
be  remembered,  however,  that  these  drugs  do  not  similarly  aft'ect  animals 
and  man.  The  reported  cases  in  favor  of  this  antagonism  have  been  se- 
verely criticized  by  Harley,  who  points  out  that  many  Avere  treated  by  other 
remedies  besides  belladonna;  in  others  a  fatal  dose  is  not  proved  to  have 
been  taken;  ajid  the  patient  who  recovered  did  not  improve  sooner  than  if 
no  belladonna  had  been  administered.  Harley  concludes,  and  in  most 
respects  he  is  directly  opposed  to  Erlenmeyer: — "  1.  That  in  medicinal 
doses  the  essential  effect  of  morphia  (hypnosis)  is  both  increased  and  pro- 
longed by  the  action  of  atropia,  whether  introduced  previously  or  at  any 
time  during  the  operation  of  the  former.  2.  That  atropia  relieves,  and 
if  given  simultaneously  or  previously,  prevents  the  nausea,  vomiting,  syn- 
cope, and  insomnia,  which  frequently  result  from  the  action  of  opium. 
3.  That  if  a  sufficient  proportion  (for  most  individuals  one  forty-eighth 
part  of  a  grain  of  sulpli.  atropia  to  a  quarter  of  a  grain  of  acetate  of  mor- 
phia) atropia  neutralizes  the  contractile  effect  of  opium  on  the  pupils; 
but  in  larger  doses  dilatation  takes  place  as  if  no  morphia  had  been  given. 
It  is  also  to  be  observed  that  if  the  qmmtivalent  doses  are  successfuUij 
introduced,  the  drug  last  administered  exhibits  for  a  short  time  a  counter- 
acting effect.  4.  That  all  the  other  effects  of  atropia  are  inteiisified  and 
prolonged  by  the  action  of  morphia  induced  previonsly  or  at  any  time 
during  the  operation  of  the  former.  If,  however,  the  dose  of  atropia  be 
small,  and  the  morphia  produce  considerable  deranging  effects  on  the 
vagus,  the  rapidity  of  the  pulse  is  not  greater  than  when  the  atropia  is 
administered  alone."  Had  Earley  given  opium  in  a  dose  just  sufficient  to 
destroy  life,  and  had  death  ensued  after  the  employment  of  belladonna, 
he  would  have  proved  that  belladonna  Avould  not  arrest  the  fatal  effects 
of  opium,  and  vice  versa.  In  no  reported  instance  did  he  use  enough  of 
either  substance  to  destroy  life;  hence  his  observations  are  not  so  convinc- 
ing as  they  might  have  been;  but  as  belladonna  intensified  the  coma  from 
opium  his  observations  are  valuable. 

On  the  other  hand.  Dr.  Johnson,  of  Shanghai,  who,  during  his  resi- 
dence in  China,  had  striking  experience  of  opium  poisoning,  having  treated 
in  various  ways  upwards  of  300  cases,  speaks  in  the  strongest  terms  of  the 
antagonism  between  opium  and  belladonna.  It  is,  he  says,  in  the  worst 
cases  of  poisoning  that  atropia  displays  its  wonderful  effects;  for  instance, 
when  the  immovable  pupils  are  contracted  to  a  pin's  point,  the  conjunc- 
tiva insensible  to  touch,  the  face  pale,  the  lips,  eyelids,  and  nails  livid, 
the  pulse  weak  and  irregular,  the  breathing  slow  and  stertorous,  the 
extremities  cold,  in  ten  or  twenty  minutes  after  the  injection  of  half  a 
grain  of  atropia  the  pupils  begin  slowly  to  dilate,  and  in  an  hour  or  so  the 
face  becomes  flushed,  the  breathing  soft  without  stertor,  and  the  pulse 
stronger.  If  witliin  two  hours  the  dose  fails  to  produce  these  restoring 
effects  Dr.  Johnson  repeats  the  injection.  In  less  profound  coma  he  first 
employs  a  quarter  of  a  grain  of  atropia. 

The  Edinburgh  Committee,  presided  over  by  Dr.  Hughes  Bennett, 
conclude : — 

1.  That  sulphate  of  atropia  is  within  a  limited  range  physiologically 
antagonistic  to  meconate  of  morphia. 

2.  Meconate  of  morphia  does  not  act  antidotally  after  a  large  dose  of 


396  BELLADONNA. 

atropia;  thus,  wliilst  atropia  is  an  antidote  of  morpliia,  morphia  is  not  an 
antidote  to  atropia. 

3.  Mcconate  of  morphia  does  not  antagonize  the  effect  of  atropia  on  the 
branches  of  the  vagi  applying  to  the  heart. 

While  there  is  doul^t  concerning  the  antagonism  between  opium  and 
belladonna,  the  interesting  ex])eriments  of  Eraser  have  demonstrated 
beyond  question  tliat  atropia  is  an  antidote  to  physostigma;  and,  as  the 
action  of  these  substances  on  man  and  animals  is  identical,  he  concludes 
that  atropia  will  neutralize  the  fatal  effects  of  physostigma  on  human 
beings.  His  experiments  were  conducted  in  three  ways: — (1.)  He  admin- 
istered the  atropia  before  the  physostigma;  (2.)  he  administered  them 
together;  (3.)  he  administered  the  physostigma,  and,  after  the  animal  was 
completely  paralyzed,  he  injected  atropia.  In  each  series  of  experiments 
atropia  averted  the  fatal  effects  of  physostigma,  although  physostigma  was 
employed  in  fatal  quantities,  as  was  afterwards  proved  by  administering 
to  the  animal  the  identical  or  even  a  smaller  dose  by  itself,  when  in  every 
instance  the  animal  speedily  died.  Fraser  concludes  that  "the  lethal 
effects  of  doses  of  physostigma  greatly  in  excess  of  the  minimum  fatal, 
may  be  prevented  by  doses  of  atropia  greatly  below  the  minimum  fatal." 
He  recommends,  that  "in  treating  cases  of  poisoning  in  a  man  the  sul- 
phate of  atropia  should  be  given  by  subcutaneous  injection,  in  doses  of 
from  one-fiftieth  to  one-thirtieth  part  of  a  grain.  The  exhibition  of  the 
antidote  should  be  persevered  with,  in  repeated  doses,  until  the  pupils  are 
fully  dilated  and  the  pulse  rate  increased,  and  probably  also  until  the 
hypersecretion  of  bronchial  mucus,  which  greatly  impedes  respiration,  is 
completely  checked." 

He  thus  summarizes  the  antagonism  between  these  "two  substances: — 
"  That  physostigma  increases  the  excitability  of  the  vagi  nerves,  while 
atropia  diminishes  and  suspends  this  excitability;  that  physostigma  di- 
minishes the  arterial  blood-pressure,  while  atropia  increases  it;  that  phy- 
sostigma greatly  augments  the  secretion  of  the  salivary,  bronchial,  intes- 
tinal, and  lachrymal  glands,  while  atropia  diminishes,  and  even  completely 
checks,  the  secretions;  and  that  physostigma  contracts  the  pupils,  while 
atropia,  to  a  much  greater  relative  extent,  dilates  tliem.  Besides  these 
effects  of  the  action  through  the  blood,  various  opposed  topical  effects 
have  been  observed,  among  which  is  the  contraction  of  the  veins  by  phy- 
sostigma— the  existence  of  which  rests  on  the  high  authority  of  Mr.  Whar- 
ton Jones — and  the  contraction  of  the  arteries  by  atropia." 

Dr.  Fraser  has  recently  published  some  further  experiments  on  the 
antagonism  between  physostigma  and  atropia,  being  led  to  this  investiga- 
tion by  reflecting  that  while,  no  doubt,  the  more  active  and  poisonous 
effects  of  physostigma  are  antidoted  by  atropia,  still,  it  seemed  possible 
that  physostigma  might  possess  some  properties — might  aff'ect  some  part 
of  the  body  in  a  manner  not  opposed  by  atropia — and  that  both  poisons 
might  possibly  possess  certain  properties  in  common,  so  that  while  some 
of  the  poisonous  properties  of  each  substance  were  antagonistic,  other 
poisonous  properties  might  not  be  so  o})posed,  nay,  might  be  similar  in 
kind  and  assist  each  other.  His  experiments  confirm  these  conjectures. 
He  found  that  after  a  minimum  fatal  dose  of  physostigma  death  could  be 
averted  by  a  dose  of  atropia,  varying  greatly  in  quantity;  but  as  he  in- 
creased the  dose  of  physostigma,  so  the  range  of  antidotal  doses  of  atropia 
became  diminished,  and  so  far  from  requiring  a  larger  maximum  antidotal 
dose,  the  greater  the  quantity  of  physostigma  administered  the  smaller 


BELLADONNA.  397 

became  the  maximum  antidotal  close  of  atropia,  till  at  last  a  point  Avas 
readied  when  atropia  ceased  to  avert  death.  For  instance,  with  a  mini- 
mum fatal  dose  of  jihysostigma,  a  dose  of  atropia  varying  from  nine- 
thousandth  to  five  grains  prevented  the  rabbit's  death;  but  on  increasing 
the  dose  of  physostigma  to  one  and  a  half  times  the  minimum  fatal  dose 
the  antidotal  dose  of  atropia  ranged  from  one-fiftieth  of  a  grain  to  four 
grains;  and  on  augmenting  the  dose  of  physostigma  to  two  and  a  half 
times  the  minimum  fatal  dose,  the  antidotal  dose  of  atropia  ranged  from 
one-fortieth  to  two  grains  and  a  half.  With  three  and  a  half  times  the 
minimum  fatal  dose  of  physostigma  the  range  of  atropia  sufficient  to  avert 
death  was  reduced  from  one-tenth  of  a  grain,  to  one-fifth  of  a  grain,  and 
with  four  times  the  minimum  fatal  dose  of  physostigma  atropia  failed  to 
avert  death.  Here,  while  atropia  prevented  the  more  powerfully  fatal 
effects  of  physostigma,  yet,  on  increasing  the  dose  of  this  drug,  a  point  at 
last  is  reached  when  its  proj^erties,  not  antagonized  by  atropia,  become 
fatal.  But  the  fatal  issue  is  not  solely  due  to  increasing  the  non- 
antagonized  properties  of  physostigma,  for  the  range  of  an  antidotal  dose 
of  atropia  became  lessened  in  proportion  as  the  dose  of  physostigma  was 
increased,  showing  that  the  atropia  assisted  the  physostigma.  The  fact  is 
also  shown  by  the  experiment  of  injecting  simultaneously  one-half  the 
minimum  fatal  dose  of  each  substance  with  the  result  of  killing  the 
animal. 

The  foregoing  .experiments,  moreover,  make  it  apparent  that  atropia 
is  an  antidote  for  only  a  given  quantity  of  physostigma,  and  that  if  the 
physostigma  is  increased  a  quantity  at  last  is  reached,  the  more  active 
properties  of  which,  no  doubt,  are  neutralized  by  atropia,  but  the  other 
properties,  in  conjunction  with  similar  ones  of  atropia,  are  sufficient  to 
cause  death. 

It  is  a  most  singular  fact,  that  while  the  minimum  fatal  dose  of  extract 
of  physostigma  is  1.2,  and  that  of  atropia  2.3  grains,  yet  the  nine- 
thousandth  of  a  grain  of  atropia  injected  five  minutes  before  giving  a 
minimum  fatal  dose  of  physostigma  prevents  its  fatal  effects;  in  fact,  a 
quantity  of  atropia  which  produces  no  perceptible  effects  will  avert  many 
of  the  serious  effects  of  a  fatal  dose  of  physostigma. 

Although  it  is  experimentally  proved  that  atropia  can  avert  death  from 
physostigma  the  question  yet  remains  unsettled  whether  physostigma  can 
prevent  death  from  atropia. 

Dr.  Fraser  conceives  that  "  with  regard  to  the  counteracting  actions 
themselves,  it  is  to  be  observed  that  various  of  the  facts  mentioned  in 
the  record  of  experiments  (of  his  paper)  tend  to  make  mutual  antagonism, 
probably  not  only  of  one,  but  of  several,  of  the  actions  of  physostigma 
and  atropia;  and  it  is  legitimate  to  suppose  that,  with  a  given  dose  of 
physostigma,  the  counter-action  produced  by  a  certain  amount  of  atropia 
will  be  more  ])erfect  in  the  case  of  one  or  more  of  the  antagonistic  actions 
than  in  that  of  others;  and  that  with  certain  doses  of  the  two  substances 
such  incompleteness  of  counter-action  may  exist  as  would,  even  without 
the  occ^urrence  of  iioii-antiigomzed  action,  suffice  for  the  production  of 
death." 

The  Edinburgh  Committee  confirm  Eraser's  statements,  but  find  that 
the  range  of  antagonism  is  even  more  restricted  than  the  limit  fixed  by 
this  investigator. 

Dr.  Brunton  has  drawn  attention  to  the  antagonism  between  atropia 
and  the  poisonous  principle  of  fungi — muscarin.     Dr.  Sclimiedeberg  had 


398  BELLAUOXNA. 

previously  pointed  out  an  antagonism  in  respect  to  the  action  of  these 
drugs  on  the  lieart;  thus,  whilst  topically  applied  muscarin  will  arrest  the 
heart  of  a  frog,  a  mere  trace  of  atropia,  applied  to  this  organ,  will  some- 
times restore  the  pulsations  even  after  the  heart  had  ceased  beating  for 
four  hours. 

The  poisons  have  likewise  an  antagonistic  action  on  the  pulmonary 
blood-vessels.  Muscarin  produces  intense  dyspncjea  and  emptiness  of  the 
arterial  system,  so  that  cut  arteries  scarcely  bleed  at  all — effects  which 
Brunton  has  proved  to  depend  on  spasm  of  the  pulmonary  vessels.  He 
narcotized  an  animal  with  chloral,  and,  after  the  lungs  were  exposed,  kept 
it  alive  by  means  of  artificial  respiration,  in  which  state  a  dose  of  musca- 
rin caused  blanching  of  the  lungs,  distention  of  the  right  side  of  the  heart 
and  vena  cava,  and  shrinking  of  the  left  ventricle.  A  little  atropia  now 
injected  into  the  jugular  vein  at  once  removed  these  phenomena;  the 
lungs  became  rosy,  the  distentions  of  the  right  side  of  the  heart  subsided, 
and  the  left  ventricle  regained  its  natural  size.  Atropia  removed  the 
dyspnoea  as  well  as  the  other  symptoms  produced  by  muscarin. 

Muscarin,  moreover,  stimulates  the  terminations  of  the  chorda  tym- 
pani  nerve,  and  increases  salivary  secretion,  exhibiting  in  this  respect  also 
an  antagonism  to  atropia.  Muscarin  also  excites  copious  perspiration. 
(See  Muscarin.) 

There  is  a  well-marked  and  interesting  antagonism  between  atropia 
and  jaborandi.  Jaborandi  excites  profuse  perspiration  and  salivation,  and 
when  applied  to  the  eye  it  contracts  the  pupil,  and,  as  Mr.  John  Tweedy 
has  shown,  causes  tension  of  the  accommodative  apparatus,  in  these 
respects  being  obviously  the  antagonist  of  atropia.  Jaborandi  also  pro- 
duces a  dull  pain  over  the  eyes,  sometimes  associated  with  giddiness;  like- 
wise over  the  pubes,  Avith  an  urgent  desire  to  pass  water,  in  these  results 
as  regards  symptoms  corresponding  to  the  action  of  atropia;  yet,  even  in 
this  respect,  these  drugs  are  opposed;  for  the  injection  of  -y-i-^  gr.  of 
atropia  not  only  speedily  checks  the  sweating  and  salivation  produced  by 
jaborandi,  but  checks  also  the  headache  and  pain  over  the  pubes,  with 
desire  to  pass  water.  Mr.  Laiigle}^  has  pointed  out  that  these  drugs  are 
antagonistic  as  regards  their  action  on  the  lieart;  thus,  jaborandi  at  first 
slows,  and  then  arrests  the  heart  in  diastole,  whilst  atropia  restores  the 
heart's  action,  even  after  its  arrest  for  a  considerable  time.  Atropia,  as  we 
have  seen,  paralyzes  the  terminations  of  the  pneumogastric  nerves,  and 
Langley  shows  that  jaborandi  at  first  stimulates  and  then  paralyzes 
these  nerves.  Its  antagonistic  effects  on  the  heart  are  not  due  to  its  in- 
fluence on  the  pneumogastric,  for  it  slows  and  stops  the  heart  after  the 
complete  paralyzation  of  the  pneumogastrics  by  curare.  The  effect  of 
jaborandi  on  the  human  lieart  ap})ears  to  be  different,  for  in  a  large  num- 
ber of  observations  I  found  that  jaborandi  always  considerably  quickened 
this  organ.  In  two  respects  these  drug  agree;  thus,  each  flushes  the  face, 
and  both  affect  children  much  less  than  adults.      (See  Jaborandi.) 

Muscarin  and  pilocarpiu,  it  is  tau.iiht,  stinnilate  the  va^i,  and  so  inliil)it  the  heart 
and  arrest  it  in  diastole.  Atropia  paralyzes  Ihe  vaiii,  and  so  prevents  tiie  "action  of 
muscarin  and  pilocarpiu.  This  view  is  no  loni;er  tenable.  Muscarin  and  jaborandi 
paralyze  the  e.xcito-niotory  apparatus  and  the  muscular  .substance  of  the  heart,  and 
atropia  must  antaii'onize  these  substances  in  these  structures.  Atropia  itself  weakens 
the  lieart,  probably  by  its  action  on  l)oth  the  excito-motor}'  and  nniscular  substance. 
So  we  have  an  instance  of  a  poison  which  paralyzes  the  excito-motory,  and  muscular 
substance  of  the  heart  antaironizins:  a  poison  Avhich  also  jiaralyzes  the  excito-motory 
and  muscular  substance.     Pilocarpiu  also  antagonizes  the  action  of  muscarin  on  the 


BELLADONNA.  399 

heart,  and  in  this  respect  it  is  almost  as  efficient  as  atropia.  Tliiis  we  have  another 
instance  of  a  paralyzer  of  the  motory  apparatus  and  muscular  substance  of  the  heart 
antagonizing  a  poison  which  affects  the  heart  in  exactly  the  same  way. 

Atropia  also  antagonizes  the  action  of  aconitia  on  tlie  heart. 

Atropia,  however,  does  not  antagonize  the  action  of  digitalis  nor  of  veratria  on  the 
frog's  heart.  Digitaline  antagonizes  the  action  of  muscarin,  pilocarpin,  aconitia,  and 
atropia. 

I  venture  to  suggest  that  these  antagonisms  may  be  due  to  chemical  displacement. 
That  atropia,  having  a  stronger  affinity  for  the  excito-niotory  and  muscular  substance 
of  the  heart  than  muscarin,  pilocarpin,  or  aconitia,  consequently  replaces  these  sub- 
stances, substituting  its  own  action  for  that  of  muscarin,  pilocarpin,  or  aconitia,  and 
atropia  is  a  much  less  powerful  paralyzer  than  muscarin,  pilocarpin  or  aconitia.  In- 
deed, atropia  only  slows  and  weakens,  but  does  not  arrest  the  heart,  whilst  muscarin, 
pilocarpin,  and  aconitia  speedily  arrest  the  heart  in  wide  diastole.  Hence,  on  the  ad- 
dition of  a  little  atropia,  we  replace  the  action  of  muscarin,  or  of  pilocarpin  or  of 
aconitia,  l)y  the  wealiening  and  slowing  action  of  atropia. 

Digitaline  and  veratria  have  a  stronger  affinity  for  the  cardiac  structures  than  even 
atropia,  and  hence  they  antagonize  the  action  of  atropia  and  of  all  the  substances  that 
atropia  antagonizes.  As,  however,  digitaline  completely  arrests  the  heart,  on  its  addi- 
tion to  a  heart  arrested  by  muscarin  or  aconitia  we  do  not  restore  the  lost  pulsations, 
but  change  the  character  of  the  heart,  converting  the  widely-dilated,  flabby,  distended 
red  heart  of  aconitia  into  the  small,  hard,  pale,  rigid  heart  of  digitalis. 

Atropia  is  antagonistic  to  bromal.  Bromal  ordinarily  destroys  life  by 
increasing  the  bronchial  and  salivary  secretion  to  so  great  an  extent  that 
tlie  animal  is  choked  by  it.  Now  atropia  checks  these  secretions,  and 
thus  prevents  the  lethal  effect  of  bromal.  Bttt,  on  the  otlier  hand,  it 
need  hardly  be  said  that  bromal  will  not  prevent  the  fatal  effect  of  atropia, 
for  this  drng  does  not  destroy  life  by  its  influence  on  the  bronchial  mucous 
membrane  or  salivary  glands. 

Dr.  John  Harley  points  out  an  interesting  antagonism  between  aconitia 
and  belladonna.  He  poisoned  a  dog  with  aconitia,  and  reduced  the  pulse 
to  G5  and  75  per  minute,  and  then  gave  gr.  l-9Gtli  of  atropia,  with  the 
speedy  effect  of  both  quickening  and  strengthening  the  heart,  and  in 
three-quarters  of  an  hour  the  heart  beat  300  per  minute,  being  230  beats 
faster  than  before  the  administration  of  atro])ia.  Harley  adduces  this 
experiment  to  show  that  atropia  affects  the  heart  by  its  stimulating  action 
on  the  sympathetic,  and  thus  atropia  both  strengthened  and  quickened 
the  heart's  beats;  but  whilst  atropia  by  paralyzing  the  vagi  might  quicken 
the  heart  it  could  not  increase  its  strength,  this  being  probably  due  to 
the  action  of  the  atropia  on  the  excito-motory  cardiac  apparatus. 

Preyer  maintains  that  atropia,  by  paralyzing  the  peripheral  branches 
of  the  vagus  nerve,  will  prevent  the  arrest  of  the  heart's  contractions,  by 
hydrocyanic  acid,  and  is  thus  an  antidote  to  it. 

That  atropia  is  separated  from  the  body  in  part  by  the  tirine  may  be 
proved  by  putting  into  the  eye  some  of  this  secretion  voided  by  one  under 
the  influence  of  belladonna.  J.  Harley  states  that  atropia  is  eliminated 
from  the  body  within  two  hours,  none  after  tliat  time  being  found  in  the 
urine. 

Dr.  Garrod  has  shown  that  caustic  fixed  alkalies  destroy  the  active 
principle  of  belladonna,  hyoscyamus,  and  stramonium,  but  that  carbonates 
and  bicarbonates  of  potash  and  soda  do  not  destroy  it.  Lime-water,  too, 
is  equally  destructive;  hence  it  has  been  recommended  as  an  antidote  in 
belladonna  poisoning.     (J.  Harley.) 


400  ETHYL-ATROPIUM. 


ETHYL-ATROPIUM.     METHYL-ATROPIUM. 

Tpie  action  of  these  substances,  in  which  an  atom  of  ethyl  or  methyl 
IS  substituted  for  a  molecule  of  H  in  atropia  has  been  studied  by  Fraser 
with  his  accustomed  tlioroughness  and  ability.  Fraser  experimented  with 
iodide  of  methyl-atropium,  sulphate  of  methyl  atropium,  and  iodide  of 
ethyl  atropium.  In  conjunction  with  Dr.  Murrell  I  have  studied  the 
actions  of  ethyl-atropium.  We  experimented  with  uncombined  crystalline 
ethyl-atropium,  prepared  for  us  by  Mr.  Wright,  under  the  direction  of 
Dr.  Graham,  Professor  of  Chemistry  at  University  College. 

From  experiments  on  frogs,  Fraser  coneludes  that  these  substances  paralyze  the 
terminations  of  the  motor  nerves,  leaving  unaffected  the  sensor}^  nerves  and  spinal 
cord.  Our  experiments  led  us  to  conclude  that  ethyl-atropium  paralyzes  the  motor- 
nerves  and  the  spinal  cord,  but  leaves  the  sensory  nerves  unaffected. 

Like  Fraser,  we  find  that  these  compounds  do  not  tetanize. 

Fraser  ascertained  that  whilst  atropia  produces  in  dogs  both  paralysis  and  convul- 
sions, ethyl-atropium  induces  only  paralysis. 

His  experiments  on  rabbits  show  that  these  substances  powerfully  paralyze  the  car- 
diac inhibitory  fibres  of  the  vagi. 

In  fatal  doses,  Fraser  finds  that  ethjd-atropium  slightly  dilates  the  pupil.  We  have 
given  it  to  men  in  doses  suttlcient  to  produce  decided  symptoms,  but  without  causing 
any  dilatation  of  the  pupil.  We  all  tind  that  its  topical  application  to  the  eye  widely 
dilates  the  pupil;  but  our  experiments  on  man  show  that  in  twelve,  or  twenty-four 
hours,  the  dilatation  nearly  or  quite  passes  off. 

In  our  experiments  on  man  this  drug,  given  in  doses  sufficient  to  produce  marked 
symptoms,  neither  strengthened  nor  quickened  the  heart;  hence  we  may  infer  that  in 
tiie  doses  we  gave  it  does  not  in  man  ]3aralyze  the  ^'agi. 

In  man,  a  dose  of  one  grain,  given  hypodermically,  produces  decided  but  transient 
paralysis,  the  patient  lieing  unable  to  stand  or  walk,  and  the  head  dropping  rather 
towards  the  shoulder  or  chest,  and  the  up])er  eyelids  drooping.  Fraser  finds  that  in 
fatal  doses  it  produces  complete  iwralysis  in  dogs  and  rabbits. 

In  man,  ethyl-atropium  excites  pain  over  the  eyes,  but,  unlike  atropia,  it  does  not 
excite  delirium  nor  produce  coma,  nor  does  it  check  the  salivary  or  the  cutaneous 
secretion. 

Fraser  finds  that  these  compounds  act  more  powerfully  on  frogs  and  rabbits  and 
dogs  than  atropia.  Oiu"  observations  confirm  his  statement  as  regards  frogs,  but  we 
find  that  the  action  of  ethyl-atroiiium  on  man  is  far  feebler  tlian  that  of  atropia.  Thus 
a  grain  given  hypodermically  excites  merely  sligiU  but  distinct  symptoms,  whilst  a 
grain  of  atropia  produces  great  weakness  and  sleep,  lasting  some  hours,  ^\^th  delirium. 

It  seems,  therefore,  that  atropia  conforms  to  Fraser's  law,  namely,  that  a  tetanizing 
alkaloid,  when  converted  into  an  ethyl  or  methyl  compound,  loses  its  tetanizing  action, 
and  produces  paralysis  of  the  motor  nerves.  But  in  the  conversion  of  atropia  into 
ethyl-atropium  and  methyl-atropium,  many  of  tlie  other  effects  of  atropia  are  lost;  thus, 
like  atropia,  these  compounds  dilate  the  pvu^il,  ]iaralyze  the  terminations  of  the  cardiac 
inhibitory  vagus  fibres,  and  paralyze,  in  a  far  greater  degree,  the  motor  nerves, 
whilst  they  lose  the  atropia  properties  of  tetanizing,  or  diminishing  the  salivary  and  cuta- 
neous secretion,  of  affecting  the  brain,  and,  according  to  Fraser,  of  paralyzing  the  cord. 

In  respect  to  the  effect  of  these  compounds  on  the  cord,  we  suggest  that  there  may 
have  been  some  slight  difference  in  the  preparation  used  by  Fraser  and  that  prepared 
for  us.  Our  observations  were  very  carefully  performed,  and  we  believe  they  may  be 
relied  upon,  and  we  feel  equally  sure  that  Fraser's  are  likewise  trustworthy;  and  only 
by  the  foregoing  assumption  can  we  reconcile  the  discrepancy  between  us. 


HYOSCYAMUS.  401 


HYOSCYAMUS 

contains  two  alkaloids,  hyoscyamin  and  hyoscin.     Hyoscin  is  by  far  the 
more  powerful. 

The  effects  of  this  drug  in  many,  if  not  in  all  respects,  correspond  to 
the  effects  of  belladonna  and  stramonium.  Thus  it  flushes  the  face, 
dries  the  mouth  and  throat,  dilates  the  pujoil,  j)roduces  a  subdued  form 
of  delirium  and  hallucijiation,  and  in  large  doses  comatose  sleep.  It 
greatly  quickens  and  strengthens  the  heart's  contraction,  and  sometimes 
produces  a  red  rash,  which,  like  that  of  belladonna,  may  be  patchy.  It 
increases  the  quantity  of  urine.  In  some  observations  made  by  Mr. 
Pearce  and  myself  it  failed  to  produce  increased  action  of  the  kidneys 
(Lawson);  poisonous  doses  produce  a  drunken  gait,  from  loss  of  volun- 
tary power,  the  drug  probably  acting  on  the  nervous  system  like  bella- 
donna. Mr.  Clifford  Gill  tells  me  that  hyoscyamia  given  in  large  doses 
Avill  induce  nausea  and  vomiting,  and  patients  in  describing  their  sensa- 
tions say  that  it  produces  a  feeling  of  "sea-sickness,"  or  "deadly  sea- 
sickness." In  some  valuable  papers  Dr.  Robert  Lawson  has  recom- 
mended hyoscyamia  in  various  forms  of  mania,  with  the  view  of  producing 
sleep,  and  substituting  a  mild  for  a  more  active  and  obstinate  delirium. 
He  gives  a  grain  to  a  grain  and  a  half,  which  in  fifteen  minutes  generally 
induces  sleep,  lasting  ten  to  twelve  hours,  when  the  patient  wakes  free 
from  delusions.  These  large  doses  cause  sleep  so  deep,  and  a  degree  of 
paralysis  so  marked,  as  to  excite  alarm  in  both  the  patient's  friends  and 
to  the  doctor  himself.  It  is  better,  therefore,  to  give  a  smaller  dose,  as 
1  6tli  to  l-8th  of  a  grain,  which  is  generally  sufficient  to  induce  several 
hours'  sleep.  Hyoscyamia  is  especially  useful  in  the  more  violent  forms  of 
intermittent  mania,  when  it  is  difficult  to  restrain  the  patient.  It  quiets 
a  patient  at  once  through  its  action  on  the  nervous  system.  I  have  tried 
this  drug  in  a  few  cases,  and  my  observations,  in  common  with  those  of 
other  observers,  entirely  corroborate  the  statements  of  Dr.  Lawson. 

I  have  tried  it  in  four  cases  of  delirium  tremens,  but  without  any 
very  satisfactory  results.  Small  doses  failed  to  produce  sleep,  but  simply 
quieted  the  violent  patient  and  substituted  the  muttering  delirium  of 
hyoscyamia  for  the  uncontrollable  delirium  of  the  disease.  Larger 
doses  produced  many  hours'  sleep,  but,  on  waking,  the  delirium  and 
general  condition  were  unamended.  In  one  case  we  gave  the  alkaloid 
several  nights  successively,  but  without  any  benefit;  then  a  dose  of 
chloral  made  the  patient  sleep  all  night,  followed  next  day  with  much 
improvement.  It  will  probably  be  useful  in  cases  where  the  patient  is 
very  violent,  and  irrestrainable,  with  delirium  like  that  of  acute  inter- 
mittent delirium.  Hyoscyamus  is  generally  used  to  produce  sleep  when 
opium  disagrees.     It  has  been  employed  also  in  neuralgia. 

Dr.  Leguin  finds  hyoscyamin  useful  in  paralysis  agitans  and  chorea. 
He  gives  l-50th  grain  daily,  hypodermically,  or  l-50th  grain  by  stomach 
night  and  morning.  It  quiets  the  movements  of  paralysis  agitans,  but 
on  discontinuing  the  treatment  the  symptoms  recur  unmitigated. 

The  fixed  caustic  alkalies  destroy  hyoscyamin,  like  atropia,  as  Dr. 
Garrod  has  proved.  The  effects  of  hyoscyamia  are  so  similar  to  the 
effects  of  atropia  and.daturia  that  I  determined  to  compare  the  operation 
of  these  three  alkaloids  in  a  case  of  acute  mania,  and  found  that  they 
produced  almost  identical  results. 
26 


402  HYOSCINE. 


HYOSCINE 

is  one  of  the  alkaloids  of  hyoscyamus  Ladenburg  first  extracted  from 
the  mother  liquid  after  hyoscyamin  was  crystallized  out.  It  is  em- 
ployed in  the  form  of  hydrobromate  or  hydriodate. 

Dr.  Horatio  Wood,  who  has  drawn  prominent  attention  to  the  drug, 
has  made  a  physiological  examination  of  it.  He  finds  that  it  depresses 
the  spinal  cord,  in  this  respect  corresponding  with  the  secondary  effect 
of  atropin.  It  leaves,  however,  the  motor  nerves  unaffected,  in  this 
differing  from  atrojiin,  which  somewhat  dejjresses  the  motor  nerves. 
Like  atropin,  it  kills  by  paralyzing  the  respiratory  centre,  and  so  arrest- 
ing respiration;  but  unlike  atropin,  when  the  frog  recovers  from  the 
I^aralysis  due  to  a  full  dose  no  tetanus  arises. 

Hyoscine  affects  the  heart  and  circulation  but  slightly;  hence  the 
blood  pressure  is  but  little  affected.  First  there  is  a  slight  fall  in  the 
pressure,  probably  due  to  the  drug  rather  weakening  the  heart.  Very 
large  doses,  like  atropia,  lower  blood  j)ressure  by  depressing  the  heart  and 
paralyzing  the  vaso-motor  centre.  Unlike  atropia,  hyoscine  slows  the 
heart,  and  in  man  the  pulse  sometimes  falls  to  48  or  50.  It  therefore 
neither  paralyzes  the  vagi  nor  the  intra-cardiac  inhibitory  apparatus. 
At  first  atropia  often  slows  the  heart,  possibly  through  its  primary  effect 
on  the  intra-cardiac  apparatus.  In  this  respect  it  corresponds  to  hyos- 
cine, for  this  drug  slows  the  heart  by  its  effect  on  the  intra-cardiac 
structures,  as  the  fall  in  the  frequency  of  the  pulsatio]is  occur  when  the 
vagi  are  cut.  Like  atropia,  it  antagonizes  the  effect  of  muscarin  on  the 
heart,  and  as  muscarin  paralyzes  the  muscular  structure  of  the  heart, 
hyoscine  must  exert  an  influence  on  the  muscular  tissue  likewise. 

Like  atropin,  it  at  first  excites  delirium,  followed  by  deep  sleep,  and 
sometimes  as  sleep  passes  off'  delirium  returns.  Patients  who  have  taken 
an  efficient  dose  feel  stupid  and  giddy,  their  movements  are  inco-ordi- 
nate,  the  face  is  often  flushed,  sometimes  pale;  they  complain  of  frontal 
headache.     In  all  these  resj)ects  again  corresponding  with  atropin. 

It  somewhat  reduces  the  frequency  of  the  respiration,  and  may  induce 
Cheyne-Stokes  breathing. 

Like  atropin,  it  dries  the  mouth  and  dilates  the  pupil;  but,  unlike 
atropin,  it  does  not  apparently  check  perspiration,  and,  in  some  cases, 
where  very  marked  symptoms  occurred,  the  skin  was  moist  with  j^erspira- 
tion.    It  is  employed  chiefly  as  a  sojiorific,  especially  in  maniacal  patients. 

In  other  cases  it  should  not  be  given  till  the  more  usual  hypnotics 
are  tried,  for  its  action  is  somewhat  uncertain,  and  the  susceptibility  to 
the  drug  greatly  varies  in  different  peojile;  hence,  symptoms  rather 
alarming  in  appearance,  though  not  dangerous,  may  arise.  It  is  the 
best  remedy  to  calm  the  delirium  of  mental  affections,  and  to  induce 
sleep.  It  is  useful  in  puerperal  mania.  From  y^  to  y^t  ^^  ^  S'^'^^'^>  given 
by  the  mouth,  is  the  dose  that  usually  succeeds,  but  ^  to  -^  may  be  re- 
quired. It  can  be  conveniently  administered,  as  it  is  tasteless.  To 
quell  mania  it  may  be  given  hypodermically  in  -y^  grain.  Wood  has 
found  it  useful  in  the  sleeplessness  arising  from  worry  or  excessive 
cerebral  activity,  or  when  the  sleep  is  much  harassed  by  dreams,  and  it 
may  succeed  when  other  soporifics  have  failed.     The  sleep  is  refreshing. 

It  is  highly  recommended  in  paralysis  agitans,. removing  the  tremor 
and  the  contracture.  On  discontinuing  the  medicine,  however,  these 
symptoms  return.     In  this  disease  ^^„  gram  is  suflicient. 


DUBOISIA    MYOPOROIDES.  403 

It  will  check  salivation,  and  the  sweating  of  phthisis.  TojDically  ap- 
plied, it  dilates  the  pupil,  its  effects  passing  off  more  quickly  than  those 
of  atropia,  but  sometimes  it  is  absorbed  in  sufficient  quantity  to  produce 
general  symptoms.     Wood  finds  it  useful  in  sj^ermatorrhroa. 

It  does  not  relieve  pain.  It  sometimes  excites  nausea  and  vomiting. 
It  is  excreted  by  the  urine. 


STRAMONIUM. 


Stramonium  produces  symptoms  very  similar  to  those  induced  by 
belladonna.  A  stramonium  ointment,  used  at  the  Middlesex  Hospital, 
is  made  by  mixing  half  a  pound  of  fresh  stramonium  leaves  with  two 
pounds  of  lard,  and  gently  heating  till  the  leaves  become  friable,  then 
straining  through  lint.  This  ointment  spread  on  lint  and  applied  thrice 
daily  relieves  pain.  Stramonium,  smoked  with  or  Avithout  tobacco,  is 
mainly  used  to  reduce  spasm  in  asthma.  It  is  especially  valuable  in 
pure  asthma,  that  is,  when  the  lungs  are  structurally  free  from  disease, 
and  is  useless  when  the  dyspnoea  is  due  to  heart  disease.  Twenty  grains 
of  the  dried  leaves,  or  ten  of  the  powdered  dry  root,  may  be  smoked, 
inhaling  meanwhile  into  the  lungs ;  or  an  inverted  tumbler,  into  which 
fumes  have  been  puffed  until  it  is  filled,  may  be  placed  over  the  mouth, 
and  the  contents  inhaled  by  a  deep  respiration.  It  excites  a  good  deal 
of  cough.  The  inhalation  may  be  repeated  again  and  again.  It  is 
better  to  smoke  the  plant  unmixed,  as  few  can  draw  the  fumes  of  tobacco 
into  the  lungs  without  great  discomfort.  There  is  no  doubt  that,  in 
many  cases  of  asthma,  stramonium  is  very  successful;  but  in  others, 
without  apparent  reason,  it  fails,  and,  even  when  it  succeeds,  its  influence 
gradually  diminishes  by  use.  Sometimes  datura  tatula  succeeds  when 
datura  stramonium  has  failed.  Dr.  Salter  believed  that  stramonium 
often  failed  owing  to  the  badness  of  the  preparation,  and  he  advised 
asthmatics  to  grow  and  prepare  their  own  stramonium.  Its  effect  is 
more  manifest  when  employed  at  the  very  commencement  of  an  attack, 
affording  but  little  relief  when  the  paroxysm  is  fully  developed.  Cold 
stramonium  smoke  can  sometimes  be  inhaled  when  the  hot  is  intolerable. 
It  has  been  used  in  neuralgia. 

Like  belladonna  and  hyoscyamus,  its  active  principle,  as  Dr.  Garrod 
has  shown,  is  destroyed  by  caustic  potash  and  caustic  soda. 


DUBOISIA  MYOPOROIDES. 

Mr.  John  Tweedy  has  introduced  into  this  country  this  solanaceous 
plant,  for  some  time  used  in  Australia.  It  yields  an  alkaloid  which 
possesses  the  same  proj^erties  as  atropia,  but  is  far  more  powerful  in  its 
action  on  man.  It  dilates  the  pupil  and  paralyzes  the  muscles  of  accom- 
modation. It  checks  perspiration,  and  dries  the  mouth.  It  produces 
delirium,  headache,  great  weakness,  and  sometimes  a  rash  similar  to  that 
of  belladonna.  It  accelerates  the  pulse  and  antagonizes  the  action  of 
musciiria  on  the  frog's  heart,  and  tetanizes  and  paralyzes.  The  alkaloid 
1^  so  powerful  that  a  1  in  120  solution  applied  to  the  eyes  often  excites 
great  giddiness,  weakness,  and  a  "  drunken  feel."  Though  duboisin 
acts  much  stronger  than  atropia  on  man,  atropia  acts  more  powerfully 
than  duboisin  on  froafs.     Duboisin  is  now  considered  as  identical  with. 


404  HYDROCYANIC    ACID. 

hyoscin,  but  in  some  respects  it  differs  from  the  accounts  given  of 
hyoscin,  for  it  certainly  checks  j^erspiration. 


HYDROCYANIC  ACID.     CYANIDE  OF    POTASSIUM. 

These  poisonous  substances  are  destructive  alike  of  animal  and  vege- 
table life. 

AVhen  applied  to  the  skin  for  a  long  time,  solutions  of  these  sub- 
stances, particularly  of  the  cyanide,  excite  some  inflammation  on  account 
of  their  alkalinity. 

Kept  in  contact  with  the  skin  for  a  while  they  diminish  sensibility. 
Formerly  they  were  employed  externally  in  painful  diseases,  such  as  neu- 
ralgia and  rheumatism;  now,  however,  they  are  quite  superseded  by  more 
successful  remedies.  But  in  allaying  the  tormenting  itching  of  urticaria, 
lichen,  eczema,  and  prurigo,  they  are  undoubtedly  very  serviceable.  The 
itching  skin  should  be  bathed  with  a  lotion  made  of  a  drachm  of  the 
cyanide  of  potassium  to  a  pint  of  water,  or  thirty  drops  of  hydrocyanic 
acid  to  the  ounce  of  water  or  glycerine.  In  respect  to  the  cyanide,  the 
action  of  the  prussic  acid  is  assisted  by  the  potash  combination  with  it. 
It  need  hardly  be  observed  that  such  a  lotion  must  not  be  applied  to  broken 
skin,  for  fear  of  poisoning  by  absorption. 

Dr.  Gee  employs  sulpho-C3'anide  of  potassium  in  tinea  tonsurans.  He 
recommends  the  hair  to  be  kept  close  cut,  and  to  Avash  the  scalp  twice  a 
day  with  warm  water  and  soap,  and  after  drying  the  head,  to  rub  well  the 
patches  with  a  lotion  composed  of  half  an  ounce  of  sulpho-cyanide  of 
potassium,  1  ounce  of  glycerine,  and  T  ounces  of  water.  The  scalp  should 
be  covered  night  and  day  with  lint  soaked  in  this  lotion,  super-imposing 
a  piece  of  oiled  silk;  a  stronger  solution  is  apt  to  excite  eczema. 

The  acid  possesses  a  bitter  characteristic  taste,  and  excites  a  sensation 
of  itching  in  the  mouth.  It  stimulates  the  flow  of  saliva,  possibly  by  its 
action  on  the  mucous  membrane  of  the  mouth. 

Taken  in  moderate  doses,  in  a  healthy  stomach  the  acid  appears  neither 
to  produce  nor  to  undergo  change;  it  is,  nevertheless,  much  used,  fre- 
quently with  benefit,  in  painful  diseases  of  this  organ,  as  in  chronic  ulcer, 
cancer,  chronic  gastritis,  gastralgia,  etc.  Not  only  does  it  occasionally 
mitigate  the  pain  of  these  affections,  but  it  may  also  check  vomiting. 

Hydrocyanic  acid  passes  very  speedily  into  the  blood,  and  is  as  speedily 
eliminated,  probably  with  the  breath;  hence,  if  life  can  be  supported  for 
half  an  liour  after  a  poisonous  dose,  the  patient  is  generally  safe. 

As  Brunton  points  out,  the  symptoms  induced  by  a  fatal  dose  of  prussic 
acid  are  identical  with  the  symptoms  of  rapid  asphyxia,  with  the  exception 
that  in  hydrocyanic  acid  poisoning  the  blood  is  arterial  in  tint  and  artifi- 
cial respiration  will  not  avert  death. 

It  is  a  general  poison,  affecting  all  parts  of  the  nervous  system  and  the 
muscles,  as  one  would  expect  in  a  remedy  that  induces  asphyxia.  It  has 
not  been  proved  how  it  induces  asphyxia,  but  it  has  been  suggested  that 
its  combination  with  ha?moglobin  lessens  oxidation.  Cyan-hsmoglobin, 
however,  is  often  aljsent  from  the  blood  in  prussic  acid  poisoning.  I^ar^e 
doses  kill  by  arresting  the  heart,  smaller  doses  kill  by  paralyzing  respiration. 
The  arrest  of  the  heart  is  partly  due  to  irritation  of  the  vagus  roots, 
and  partly  due  to  the  action  of  the  poison  on  its  ganglia  and  muscular  tis- 
sue.    It  first  raises  arterial  pressure,  but  soon  lessens  it. 


OPIU3I.  405 

From  his  experiments  on  frogs,  Kolliker  concludes  that  it  paralyzes  first 
the  brain,  next  the  cord,  and  then  the  motor  nerves,  the  paralysis  extending 
from  the  trunk  to  the  periphery.  It  paralyzes  the  heart,  its  action  ceas- 
ing in  diastole.  The  voluntary  muscles  soon  lose  their  irritability,  and 
become  stiff.  Preyer  maintains  that  a  large  dose  of  hydrocyanic  acid  par- 
alyzes the  heart  at  once;  that  moderately  fatal  doses  deprive  the  blood  of 
oxygen ;  and  that,  as  belladonna  paralyzes  the  peripheral  branches  of  the 
vagus,  and  at  the  same  time  stimulates  the  nervous  centres  of  respiration, 
atropia  in  these  cases,  h3q3odermically  injected,  will  prevent  death.  Hy- 
drocyanic acid  is  a  useful  addition  to  cough  mixtures,  to  allay  irritable 
cough.  Syrup  of  Virginian  prune,  which  is  often  employed  in  cough 
mixtures,  probably  owes  its  efficacy  to  the  prussic  acid  it  contains. 


OPIUM. 

Opium  chiefly  afPects  the  brain  physiologically,  and  therefore  thera- 
peutically, and  in  the  lower  animals  excites  tetanus  by  its  action  on  the 
cord.  It  has  very  little  action  on  either  sensory  or  motor  nerves,  though 
some  observers  maintain  that  it  first  stimulates  and  then  depresses  sen- 
sory nerves.  Large  doses  paralyze  the  vaso-motor  centre.  The  muscles 
are  unaffected  by  it. 

Small  doses  of  opium  excite  tetanus  in  frogs;  but  birds,  such  as  ducks, 
chickens,  and  pigeons,  cannot  be  poisoned  by  crude  opium,  by  aqueous 
extract,  nor  by  black  drop  (acetum  opii),  given  internally;  and  morphia 
salts  must  be  given  in  enormous  doses.  Morphia  employed  hypoder- 
mically  in  very  large  doses  never  causes  sleep  nor  stupor,  but  convulsions. 
Thebaia  is  a  tetanizing  agent,  inferior  only  to  strychnia  and  brucia.  Nar- 
cotina,  almost  without  effect  on  man,  destroys  birds  in  doses  of  two  to 
seven  grains  when  used  hypodermically.  Codia  is  a  fatal  convulsive  agent 
to  pigeons.  Meconia  given  internally  causes  emesis.  but  is  harmless  when 
injected  under  the  skin.  Narceia  has  no  perceptible  influence,  except  to 
disturb  the  respiration  slightly.  Cryptopia  in  doses  of  one-fifth  to  one- 
half  a  grain  has  no  effect.  None  of  these  agents  cause  sleep  in  pigeons, 
ducks,  or  chickens.     (Dr.  Weir  Mitchell.) 

Dogs,  cats,  and  rabbits  require  larger  doses  of  opium  to  produce  stupor 
or  sleep,  which  is  generally  accompanied  by  convulsions.  In  the  lower 
animals,  like  frogs,  opium  only  excites  tetanus;  but  as  we  ascend  in  the 
animal  kingdom  the  soporific  effects  become  apparent,  and  are  most 
marked  in  man.  Race  modifies  the  effects  of  opium,  for  it  drives  the 
Japanese  and  ^Malays  into  temporary  madness;  and  even  among  Europeans 
its  effects  vary  considerably  in  different  individuals.  In  some  persons, 
especially  women,  it  produces  much  excitement  but  no  sleep,  the  excite- 
ment being  sometimes  pleasant,  at  other  times  extremely  disagreeable.  In 
some  instances  if  it  fails  to  induce  sleep  it  soothes,  and  pleasant  ideas 
occup}'  the  mind;  with  other  persons  it  induces  restlessness,  excitement, 
and  even  delirium. 

Preparations  of  opium,  applied  by  means  of  poultices  or  friction,  are 
absorbed  by  the  unbroken  skin. 

Poultices  containing  laudanum  are  used  to  allay  the  pain  of  superficial 
and  even  of  deep-seated  infiammations,  and  enough  may  be  absorbed  in 
this  way  to  produce  deep  sleep.  Friction  considerably  increases  the  ab- 
sorption;   thus  linimoit  of  opium,  well  rvibbed  in,  relieves  neuralgias. 


406  OPIUM. 

pleurodynia,  and  myalfj^ia.  The  al)raded  skin  absorbs  still  more  freely, 
and  preparations  of  opium  or  morphia  are  applied  to  irritable,  cancerous, 
and  simple  sores.  JMorphia,  dissolved  in  glycerine  and  spread  on  lint,  is 
a  useful  application  to  a  painful  cancerous  sore. 

The  hypodermic  injection  of  morphia,  originated  by  Dr.  Alexander 
Wood,  is  now  extensively  employed  to  relieve  pain,  produce  sleep,  prevent 
spasm,  and  for  other  purposes,  and  is  preferable  to  the  administration  of 
the  drug  by  the  mouth.  Its  action  is  more  rapid,  its  effects  more  per- 
manent, and  it  neither  destroys  the  appetite  nor  constipates  the  bowels. 
At  first  not  more  than  a  sixth  part  of  a  grain  should  be  injected;  a  larger 
quantity  sometimes  produces  serious  symptoms. 

An  injection  not  unfrequently  causes  a  good  deal  of  excitement,  giddi- 
ness, even  intoxication,  great  nausea,  and  repeated  vomiting,  followed  by 
considerable  depression.  Often,  indeed,  the  patient  is  unfitted  for  work 
during  the  rest  of  the  day.  These  inconveniences,  however,  can  mostly 
be  avoided  by  keeping  the  patient  recumbent  for  some  hours  after  the  in- 
jection. Belladonna  seems  to  obviate  these  unpleasant  symptoms,  if 
combined  with  morphia  in  the  relative  proportion  of  twenty  parts  of  mor- 
phia to  one  part  of  atropia. 

An  injection  occasionally  jiroduces  redness  of  the  face,  contraction  of 
the  jaw,  dyspnoea,  clonic  spasms  of  the  limbs,  hammering  frequent  pulse, 
symptoms  which  last  about  five  minutes,  followed  on  their  decline  by  vio- 
lent sweating.  These  symptoms  are  said  to  occur  when  the  injection 
directly  enters  a  vein.  By  long  persistence  in  hypodermic  injections 
the  system  becomes  habituated  to  opium,  so  that  not  only  must  the 
quantity  be  increased,  but  when  discontinued  a  patient  suffers  the  de- 
pressing effects  of  an  opium-eater  deprived  of  his  opium. 

Sometimes  so  severe  are  these  sufferings,  that  patients  declare  that 
the  distress  occasioned  by  the  intermission  of  the  injection  is  worse  than  the 
pain  itself.  The  injection  may  be  made  in  any  part  of  the  body;  but,  for  the 
sake  of  convenience,  it  is  better  to  choose  a  place  where  the  skin  is  loose.  A 
fold  of  skin  should  be  pinched  up  firmly,  and  then  the  needle  thrust  quickly 
through  it  into  the  subcutaneous  tissue.  If  patients  dread  the  slight  pain 
of  the  puncture,  the  sensibility  of  the  skin,  may  be  first  deadened  by  the 
ether  spray,  or  by  the  application  of  a  piece  of  ice  dipped  in  salt.  If 
a  patient  administers  a  hypodermic  injection  to  himself  he  can  conveniently 
nip  up  the  skin  with  a  wooden  clip,  this  contrivance  enabling  him  to  in- 
ject the  solution  in  his  arm,  Avhen  of  course  he  can  only  use  one  hand. 
It  is  hardly  necessary  to  say  that  it  is  rarely  advisable  to  allow  a  patient 
to  administer  the  injection  himself.  Immediately  after  the  injection,  a 
sharp  smarting  pain  is  felt,  and  in  many  cases  a  large  flat  wheal,  like  that 
of  urticaria,  soon  arises.  If  care  is  taken  to  make  the  solution  as  nearly 
neutral  as  possible,  the  pain  is  much  reduced.  It  should  be  remembered 
that  these  injections  sometimes  leave  a  hard  horny  cicatrix;  hence  it  is  im- 
portant to  inject  some  part  of  the  skin  covered  by  the  clothes. 

Eulenberg  states  that  the  sensibility  round  the  punctured  spot  is 
lessened  if  the  injection  is  made  over  a  superficial  sensory  nerve;  and  that 
the  sensibility  of  the  Avhole  skin  territory  of  this  nerve  is  somewhat 
blunted. 

A  single  injection  sometimes  cures  recent  and  even  long-standing 
sciatica,  facial  and  other  neuralgias,  biit  it  usually  gives  only  temporary 
relief,  and  the  injection  miist  Ije  repeated  from  time  to  time. 

Injections  continued  for  days,  weeks,  or  perhaps  months,  sometimes  cure 


OPIUM.  407 

obstinate  cases  of  neuralgia  and  its  allies.  Sometimes  ever}'  second  day,  or 
twice  a  week,  is  sufficient  to  mitigate  the  pain  and  after  a  time  to  cure. 
A  single  injection  frequently  cures  lumbago  at  once;  but,  as  the  mere 
insertion  of  a  needle  is  often  equally  efficacious,  some  of  the  speedy  cures 
attrilnited  to  the  injection  must  be  due  to  the  effects  of  unintended  acu- 
pimcture.  Hypodermic  injection  relieves  the  pain  of  severe  pleurodynia, 
but  most  cases  of  pleurodynia  yield  to  milder  treatment.  It  is  particu- 
larly efficacious  in  the  pain  of  renal,  biliary,  and  intestinal  colic. 
Although  not  often  required,  a  mild  morphia  injection  will  allay  severe 
toothache.  Morphia  injections  are  sometimes  needed  to  relieve  the  pain 
of  acute  inflammations,  like  pleurisy  and  pneumonia,  but  are  rarely  re- 
quired unless  the  suffering  is  severe  or  persistent. 

Morphia  injections  are  used  to  produce  sleep.  Morphia,  subcutaneously 
injected,  acts  more  speedily  and  in  smaller  quantities  than  when  swallowed. 

Morphia  is  injected  to  produce  sleep  in  acute  mania,  delirium  tremens, 
chorea,  etc.  In  delirium  tremens,  even  when  bromide  of  potassium  and 
chloral  have  failed,  an  injection  often  speedily  produces  sleep.  A  mor- 
phia injection  is  useful  in  chorea  when  the  movements  prevent  sleep,  and 
when  wakefulness,  by  weakening  the  patient,  increases  the  movements. 
Dr.  Clifford  Allbutt  employs  morphia  injections  in  dyspepsia  of  an  irrita- 
ble kind,  when  the  patient  is  spare,  fretful,  keen,  hasty,  or  absent  in 
manner,  with  a  tongue  too  clean,  red  at  tip  and  edges,  small  pulse,  and 
broken  sleep. 

Dr.  Allbutt  strongly  recommends  a  morphia  injection  in  the  dyspnoea 
of  heart  disease,  and  in  disease  of  tlie  large  vessels,  in  the  pain  of  angina 
pectoris,  and  of  intra-thoracic  tumors.  By  removing  dyspnoea  it  permits 
sleep,  and  recruits  the  worn-out  patient.  It  strengthens  the  heart,  and 
so  removes  congestion  of  the  lungs  and  face.  Dr.  Allbutt  considers  it 
less  useful  in  aortic  than  in  mitral  disease.  I  have  long  employed  these 
injections  in  heart  disease,  and  can  corroborate  Dr.  Allbutt's  statements. 
It  is  hardly  possible  to  exaggerate  the  relief  this  treatment  confers  on  a 
patient  suffering  from  cardiac  dyspnoea.  Almost  directly  on  falling  asleep, 
a  severe  sensation  of  dyspnoea  comj)els  the  patient  to  awake  and  sit  upright 
in  bed;  he  often  says  that  the  distress  from  want  of  sleep  is  harder  to  bear 
than  other  serious  sufferings.  The  appetite,  already  bad,  becomes  worse, 
lack  of  sleep  and  weakness  rapidly  set  in.  In  such  a  case  the  comfort 
afforded  by  a  hyijodermic  injection  is  almost  incredible.  It  ensures  several 
hours'  refreshing  sleep,  from  which  the  patient  awakes  wonderfully  re- 
vived, and  the  dyspnceal  attacks  for  the  next  twenty-four  hours  are 
warded  off.  The  heart,  thus  strengthened,  and  in  the  case  of  mitral 
disease  the  pulse  made  more  regular  and  slower,  the  patient's  condition 
is  not  only  notably  relieved,  but  his  life  is  prolonged.  J^  must  be  borne 
in  mind  that,  in  heart  disease,  the  cardiac  dyspnoea  is  often  associated 
with  another  form  of  dyspncea  arising  from  dropsy  of  the  pleura,  and  of 
the  lung.  The  dyspnoea  due  to  these  two  causes  is  permanent;  whilst 
the  dyspnoea  due  to  the  heart  is  paroxysmal,  and  generally  occurs  only  on 
falling  asleep.  The  hypodermic  injection  of  morphia  will  not  relievo  per- 
manent dyspnoea  or  orthopnoea — conditions  best  treated  by  incisions  into 
the  dropsical  legs,  to  drain  away  the  dropsical  fluid.  In  cardiac  dypsnoea, 
a  sixth  of  a  grain  twice  or  three  times  a  week  often  suffices,  but  the  dose 
and  frequency  in  severe  cases  must  be  gradually  increased  to  a  quarter  of 
a  grain  each  night.  Doctors  are  often  afraid  to  administer  morphia  in 
the  case  of  a  patient  propped  up  in  bed,  with  livid  ears,  nose  and  nails. 


408 


OPIUM. 


with  distended  jugulars  and  dropsical  extremities,  with  weak,  frequent, 
and  irregular  pulse.  They  dread  lest  the  morphia  should  weaken  the 
heart,  make  the  patient  Avorse,  if  not  kill  him  outright.  This  fear  is 
quite  groundless,  and  this  treatment  may  be  employed  Avithout  any  ap  • 
prehension  of  injury  to  the  patient,  even  if  in  a  rare  instance  it  should 
fail  to  benefit. 

Dr.  Spender  employs  morphia  injections  to  arrest  the  severe  vomit- 
ing of  pregnancy  and  other  obstinate  and  dangerous  forms  of  vomiting. 
An  injection  often  arrests  persistent  hiccup,  and  sometimes  puerperal 
convulsions;  it  has  likewise  been  successfully  employed  in  tedious  labor, 
produced  by  a  rigid  os  uteri. 

Dr.  T.  J.  Gallagher,  of  Pittsburg,  and  more  recently  Dr.  John  Patter- 
son, of  Constantinople,  have  witnessed  great  benefit  from  the  hypoder- 
mic injection  of  morphia  in  cholera,  even  in  the  stage  of  collapse.  The 
cramps  and  vomiting  cease,  the  patient  falls  asleep,  the  skin  gradually 
becomes  Avarm,  and  the  pulse  returns.  They  employ  one-fourth  to  one- 
eighth  of  a  grain  of  morphia,  and  usually  one  or  tAvo  injections  suffice. 
In  the  early  stages  the  patient  falls  asleep  and  AA^akes  almost  Avell.  Dr. 
Patterson  has  employed  this  treatment  for  children.  Many  subsequent 
observers,  however,  deny  the  efficacy  of  hypodermic  injection  in  Asiatic 
cholera.  A  small  hypodermic  injection  of  J,t  to  ^  of  a  grain  of  morphia 
is  most  useful  in  the  choleraic  diarrhrea  of  children.  The  sickness  and 
vomiting  cease.  The  surface  becomes  Avarm,  the  child  falls  asleep,  and 
wakes  well-nigh  cured. 

I  have  often  seen  hypodermic  injections  promptly  cure  sporadic  Eng- 
lish cholera,  checking  at  once  cramp  and  inducing  sleep,  the  patient 
waking  free  from  sickness  or  diarrhoea. 

Dr.  BraithAvaite  has  successfully  given  small  doses  of  morjohia  hypo- 
dermically  in  haemoptysis. 

A  hypodermic  injection  of  morphia  is  sometimes,  as  Mr.  Hunter  has 
pointed  out,  very  useful  in  melancholia.  I  have  seen  a  patient  dread- 
fully depressed,  whose  expression  became  completely  altered,  and  Avho 
at  these  times  Avas  weak  and  tottery,  and  Avithout  appetite.  Five  minutes 
after  the  injection  this  man  became  himself  again.  His  depression  and 
weakness  left  him,  his  natural  expression  returned,  and  he  could  at  once 
take  a  walk  of  several  miles,  and  return  home  and  eat  a  good  meal.  It 
is  a  most  difficult  question  to  decide  Avhether  in  such  a  case  the  doctor 
is  Avarranted  in  permitting  the  injection,  lest  the  patient  become  the 
victim  of  the  opium  habit.  But  I  must  confess  that,  seeing  the 
wonderful  transformation  it  has  caused,  how  the  patient  has  passed  from 
utter  Avretchedness  to  happiness  and  serenity,  I  have  not  been  able  to 
prohibit  its  usc-^ 

Dr.  Buxton  Sliillitoe  strongly  recommends  for  carbuncles  and  boils 
the  local  application  of  an  extract  of  opium,  the  consistence  of  treacle. 
The  extract  must  be  thickly  smeared  three  or  four  times  a  day  over  and 
around  the  SAvelling.  Applied  early,  it  often  causes  the  boil  to  abort; 
or  it  limits  its  progress  and  eases  pain.  After  the  extract,  Mr.  Shillitoe 
applies  a  plaster,  composed  of  equal  parts  of  soap,  opium,  and  mercury, 
spread  on  thick  leather.  Should  suppuration  set  in,  he  lets  out  the 
matter,  and  applies  a  poultice  over  a  small  hole  cut  in  the  plaster. 

Dropped  into  the  eye,  laudanum  and  solutions  of  morphia  cause 
smarting,  redness,  and  slight  inflammation  of  the  conjunctiva.     They 


opimr.  409 

contract  tlic  pupil,  but  in  a  less  degree  than  if  administered  in  other 
"ways.  Opium,  however,  is  never  used  specifically  to  contract  the  pupil, 
Calabar  bean  effecting  this  more  safely,  easil}^  and  thoroughly.  Opium 
wine,  dropped  into  the  eye,  is  used  to  relieve  the  pain  of  conjunctivitis, 
and  by  slight  stimulation  to  improve  the  condition  of  the  membrane. 
The  wine  of  the  present  Pharmacopoeia,  containing  spices,  must  not  be 
so  employed,  as  it  would  aggravate  the  mischief;  but  the  wine  of  the 
Pharmacopoiia  of  1804  must  be  used.  Mixed  with  either  tannin  or 
creasote,  opium  is  introduced  into  the  hollow  of  a  painfnl  tooth,  and  if 
the  23ain  is  produced  by  inflammation  of  the  exposed  pulp,  this  applica- 
tion often  gives  relief. 

A  somewhat  full  dose  of  opium  produces  much  disagreeable  dryness 
of  the  mouth  and  throat.  The  same  annoying  symptom  follows  likewise 
on  the  hyijodermic  injection  of  morphia. 

The  preparations  of  opium  are  rarely  used  for  their  topical  effect 
on  the  throat,  but  their  good  effects  are  often,  I  think,  due  to  the  local 
action.  For  instance,  many  coughs,  as  in  some  cases  of  phthisis,  are 
really  produced  by  the  condition  of  the  throat, — red,  inflamed,  and  even 
ulcerated — a  condition  which  excites  much  irritation,  and  a  frequent 
hacking  cough,  especially  troublesome  at  night.  Tlie  topical  applica- 
tion of  morphia  dissolved  in  glycerine,  honey,  treacle,  syrup  of  Virginian 
prune,  mucilage,  or  some  other  viscid  substance,  which  causes  the  mixture 
to  linger  some  time  over  the  irritable  membrane,  often  relieves  this  kind 
of  cough.  It  is  well  known  that  the  cough  of  chronic  phthisis  is  often 
best  treated  by  directing  the  patient  to  retain  for  some  time  in  the 
pharynx  a  weak  solution  of  morphia  in  glycerine,  honey,  syrup,  or 
mucilage,  so  as  to  blunt  the  irritability  of  these  parts.  Heiice,  too,  the 
excellent  effects  of  morphia  lozenges  allowed  to  dissolve  slowly  in  the 
mouth.  Even  in  coughs  entirely  dependent  on  lung  disease,  opium  or 
morphia  administered  so  that  the  medicine  clings  for  some  time  in 
contact  with  the  structures  just  outside  the  larynx,  appear  to  have  a 
greater  influence  tlian  when  the  mediciiie  is  conveyed  tjuickly  into  the 
stomach.  This  result  is  probably  due  to  the  fact,  heretofore  insisted 
on,  that  drugs  appear  to  possess  remedial  virtues  over  the  organs  of 
the  body,  even  when  applied  only  to  the  orifice  of  the  passages  leading 
to  them. 

The  following  is  a  good  formula  to  allay  coughs:  Morphia,  one- 
fortieth  part  of  a  grain;  spirits  of  choroform,  three  minims,  in  a  drachm 
of  glycerine,  syrup  of  lemons,  diluted  honey  or  treacle,  repeated  fre- 
quently at  times  when  the  cough  is  troublesome,  till  the  paroxysm  is 
subdued. 

It  is  often  taught  that  morphia  should  not  be  gi^en  in  catarrh  or 
bronchitis.  When  the  expectoration  is  abundant,  and  there  is  duskiness 
of  the  skin,  showing  deficient  oxidation,  opiates  or  other  narcotics  that 
produce  j^rofound  sleep  must  of  course  be  given  very  guardedly,  other- 
wise the  expectoration  during  sleep  may  accumulate  in  the  lungs,  and 
give  rise  to  serious  results.  On  the  other  hand,  we  meet  with  cases  of 
free  expectoration,  with  very  little  rhonchus,  and  no  signs  of  obstructed 
oxidation,  and  very  violent  and  frequent  cough.  In  such  cases  opiates 
relieve  cough,  and  lessen  expectoration;  for  the  secretion  of  mucus  in 
the  bronchial  tubes  is  certainly  stimulated  by  violent  coughing,  nnd  when 
this  is  allayed,  the  exjDectoration  becomes  much  less  abundant.     That 


410  OPIUM.  ^ 

coughing  m;iy  excite  secretion  in  the  bronchial  tubes  is  sliown  by  the 
common  fact,  that  if  a  patient  can  restrain  his  cough,  the  expectoration        f 
becomes  less,  without  any  signs  of  accumulation  in  the  lungs.  ' 

Taken  into  the  stomach,  opium  lessens  both  its  secretion  and  its 
movements,  and  consequently  checks  digestion.  Its  retarding  effect  on 
digestion  is  exemplified  by  the  well-known  fact,  that  when  an  opiate  is 
given  too  near  a  meal,  the  food  vomited  hours  afterwards  is  only  very 
partially  digested.  Xay,  according  to  Bernard,  a  hypodermic  injection 
may  have  this  effect,  for  he  found  the  crops  of  pigeons  full  after  a  hy- 
podermic dose  of  morphia.  Here  we  have  a  sufficient  reason  why  opiates 
should  not  be  given  shortly  before  or  after  a  meal,  unless,  indeed,  it  is 
intended  to  diminish  appetite,  or  to  hinder  the  natural  movements  of 
the  stomach. 

Opiates  not  uncommonly  excite  nausea  and  vomiting,  symptoms  very 
apt  to  occur  in  the  morning  after  a  night  dose. 

Opium,  or  its  alkaloid,  morijhia,  is  given  to  quell  the  pain  of  many 
stomach  affections,  and  to  check  the  vomiting  which  may  accompany 
them.  Thus  it  is  useful  in  cancer  and  chronic  ulcer  of  the  stomach,  and 
in  chronic  gastritis  from  excessive  indulgence  in  alcoholic  drinks. 
Morphia,  in  small  doses,  combined  with  tonics,  taken  a  short  time  before 
meals,  is  very  efficacious  in  removing  the  pain,  the  nausea,  and  want  of 
appetite,  so  often  connected  with  alcoholism.  In  the  treatment  of 
gastrodynia  with  heartburn,  it  is  usefully  combined  with  bismuth. 

The  effects  of  opium  on  the  intestines  are  identical  with  those  on 
the  stomach;  that  is  to  say,  it  checks  both  secretion  and  movement,  thus 
constipating  the  bowels  in  health  and  restraining  diarrhoea  in  disease. 
Constipation,  one  of  the  disagreeable  consequences  following  an  opiate, 
is  much  less  marked  when  morphia  is  employed  hypodermically. 

Some  persons  can  never  take  even  a  small  dose  of  laudanum  or 
morphia,  without  producing  for  a  day  or  two  clay-colored  motions  and 
high-colored  urine. 

Opium,  or  its  alkaloid,  morphia,  is  very  frequently  and  very  benefi- 
cially given  in  both  acute  and  chronic  diarrhcea.  It  is  useful  in  the 
acute  forms,  after  the  expulsion  of  the  disturbing  irritant.  It  is,  more- 
over, of  great  use  in  the  chronic  diarrhoeas  of  tuberculosis,  dysentery, 
and  other  organic  diseases. 

In  typhoid  fever,  opium  in  small  doses,  given  at  night,  may  serve  a 
double  purpose.  In  wakefulness,  with  delirium,  whether  of  boisterous 
or  muttering  kind,  opium  will  often  produce  sleep,  and  thus  check  the 
delirium,  while  at  the  same  time  it  will  control  or  even  subdue  the 
diarrhoea. 

There  is  a  form  of  dyspepsia  and  diarrhoea  which  yields  to  small 
doses  of  opium.  There  is  probably  increased  peristaltic  action  of  the 
stomach  and  intestines,  so  that  the  food,  soon  after  it  is  swallowed,  is 
forced  in  a  half-digested  state  through  the  pylorus  into  the  intestines, 
where,  owing  to  its  crude  condition,  it  acts  as  an  irritant,  exciting  the 
vermicular  action,  already  acting  unduly,  so  that  a  diarrhcea  of  partially 
digested  food  occurs  soon  after  a  meal.  The  patient  suffers  from  a  sen- 
sation of  emptiness  and  hunger,  which  is  relieved  for  a  short  time  by 
food;  but  the  meal  being  imperfectly  digested,  and  exi^elled  through 
the  anus  long  before  it  can  be  absorbed,  the  system  is  imperfectly 
nourished,  and  these  uncomfortable  symptoms  soon  recur.     The  char- 


OPIUM.  411 

acteristic  symj)toms  are — sinking  at  the  stomach,  relieved  for  a  short 
time  by  taking  food,  and  the  occurrence  of  an  evacuation  of  partially 
digested  food  immediately  after  a  meal,  nay,  sometimes  even  before  it 
is  finished,  and  generally  at  no  other  time.  This  complaint,  a  common 
form  of  chronic  dyspepsia  in  children  from  six  to  twelve  years  of  age, 
is  quickly  arrested  by  administering  from  two  to  five  drops  of  tincture 
of  opium  a  few  minutes  before  each  meal,  a  dose  which  seems  to  check 
the  excessive  muscular  action,  and  so  enables  the  food  to  tarry  a  suffi- 
cient time  to  undergo  digestion.  Still  more  effective  in  such  cases  is 
arsenic. 

Colic  of  the  intestines  is  well  combated  by  small  doses  of  opium  or 
morj)hia  frequently  repeated.  As  this  painful  aifection  is  generally  ac- 
companied by,  and  is  dependent  on  constijDation,  a  purgative  should  like- 
wise be  given.  The  opium  assists  the  purgative  by  relaxing  that  con- 
traction of  the  intestines  which  hinders  the  j)assage  of  the  intestinal 
contents. 

Opium  quiets  the  intestinal  movements  in  inflammation  of  the  peri- 
toneum and  of  the  intestines,  or  in  wounds  of  the  abdomen.  Opium  is 
useful  in  peritonitis,  not  only  by  restraining  the  intestinal  movements, 
but  by  its  direct  beneficial  influence  on  the  inflammation;  and  the  dose 
must  be  rapidly  increased  up  to  the  limit  of  toleration,  to  the  extent  of 
very  large  doses  of  several  grains  every  two  or  three  hours. 

Opiates  are  administered  by  the  rectum  for  a  variety  of  purposes. 
Laudanum  is  usually  injected  mixed  with  an  ounce  of  decoction  of 
starch,  at  a  temperature  of  100''  or  thereabouts,  and  is  very  efiectual 
in  checking  acute  and  chronic  diarrhoea;  and  in  those  severe  forms  of 
diarrhoea  which  sometimes  carry  off  young  children  in  a  few  hours,  a 
laudanum  injection  is  often  the  speediest  way  of  controlling  the  danger- 
ous flux.  When  other  methods  fail,  the  same  injection  often  checks 
the  purging  of  typhoid  fever,  or  of  ulceration  of  the  intestines,  or  of 
dysentery-.  It  is  highly  useful  in  pain  of  the  bowels  and  of  the  organs 
in  the  neighborhood  of  the  rectum.  Thus,  an  opiate  injection  will 
generally  subdue  the  pain  and  frequent  micturition  of  cystitis,  and  the 
pain  arising  from  various  uterine  diseases.  A  suppository  of  opium  or 
morphia  is  sometimes  introduced  into  the  rectum  as  far  as  the  finger 
can  conveniently  carry  it,  but  the  injection  of  the  laudanum  and  starch 
is  more  effectual. 

Opium  mixed  with  gall  ointment  is  an  excellent  application  to  pain- 
ful bleeding  piles,  and  to  fissures  of  the  anus,  which  cause  excruciating 
pain  with  much  evacuation.  Mild  purgatives  should  be  simultaneously 
employed. 

Ojnum  injected  into  the  rectum  is  absorbed,  and  affects  the  distant 
organs  of  the  body.  A  rectal  injection  will  sometimes  induce  sleep 
when  the  ordinary  method  of  administering  it  by  the  mouth  completely 
fails.  In  obstinate  forms  of  dyspejitic  sleeplessness,  or  the  wakefulness 
of  convalescents  from  acute  disease,  the  injection  of  laudanum  by  the 
rectum  will  often  prove  successful.  Both  Dupuytren  and  Graves  state 
that  in  delirium  tremens  and  traumatic  delirium,  this  mode  of  giving 
opium  is  preferable  to  its  administration  by  the  mouth.  The  dose  of 
laudanum  injected  in  the  rectum  must  depend  on  the  nature  of  the 
case.  If  employed  to  relieve  local  pain,  a  small  quantity  will  generally 
suffice;    but  to  produce  sleep,  a  dose  must  be  given  about  threefold  or 


412  OPIUM. 

fourfold  that  administered  by  the  stomach— at  least,  so  it  is  generally 
taught;  but  an  ordinary  medicinal  dose,  even  when  given  by  the  rectum 
— well  cleared  out  previously  by  a  simple  enema  or  a  purgative — is  often 
amply  sufticient  to  ensure  sleep. 

The  active  principles  of  opium  readily  pass  unaltered  into  the  blood ; 
for  whether  the  opium  is  swallowed  or  injected  under  the  skin,  the 
same  symptoms  are  induced. 

To  one  unaccustomed  to  opium  a  small  dose  produces  a  soothing  and 
luxurious  mental  calm,  followed  in  the  course  of  forty  or  fifty  minutes 
by  a  disposition  to  sleep;  if  this  does  not  happen,  the  drug  gives  general 
repose  to  both  body  and  mind.  The  pulse  at  first  quickens  slightly,  in 
ten  to  twenty  minutes,  by  eight  or  ten  beats;  but  in  half  or  three-quarters 
of  an  hour,  it  again  falls ;  at  first  it  is  made  stronger  and  more  resistant. 
The  mouth  and  pharynx  are  dry,  and  perspiration  often  breaks  out. 
Larger  doses,  as  from  two  to  three  grains,  generally  at  first  2)roduce  much 
excitement,  with  noises  in  the  ears,  and  closely  contracted  inipils.  The 
ideas  are  confused  and  extravagant,  and  decided  delirium  may  occur; 
the  head  feels  heavy  and  full,  the  senses  are  blunted,  and  then  follows 
sleep,  which  is  often  heavy,  even  stertorous,  and  harassed  by  disagreeable 
dreams,  while  the  pulse,  at  first  full  and  frequent,  soon  becomes  slow. 

The  susceptibility  to  the  action  of  opium,  and  the  symptoms  it  pro- 
duces, vary  greatly  in  different  persons.  Some  are  so  easily  affected  by 
opium  that  even  a  small  quantity  endangers  life;  a  susceptibility  so  ex- 
treme is,  however,  not  common.  In  some  it  produces  only  disagreeable 
sensations  and  ideas,  in  others  just  the  reverse;  in  some  the  stimulant 
effects  predominate,  in  others  the  narcotic.  Some  persons  after  a 
moderate  dose  of  opium  never  become  heavy  or  drowsy,  but  feel  the 
drug  diffuse  a  glow  throughout  the  body,  followed  by  a  luxuriant  calm 
of  mind  and  body.  I  have  heard  some  i3eo2:)le  who  were  not  accustomed 
to  opium  say  they  dare  not  take  opium,  for  the  sensations  it  produces  are 
so  delicious  that  they  feared  the  temptation  to  take  opium  might  become 
irresistible.  There  are  others,  again,  who  after  even  a  minute  dose 
become  excited,  restless,  sleepless,  and  even  delirious. 

After  a  poisonous  dose  the  primary  stage  of  excitement  is  very  brief, 
and  narcotism  rapidly  supervenes.  Great  giddiness  and  a  sensation  of 
oppression  come  on,  with  an  irresistible  craving  for  sleep.  There  may 
be  both  nausea  and  sickness.  The  sleep  soon  passes  into  profound  in- 
sensibility, the  breathing  grows  slower  and  slower  and  more  and  more 
shallow,  till  it  ceases.  The  face  is  pale,  or  livid  and  bloated,  and  the 
veins  swollen.  The  pulse,  at  first  full  and  strong,  becomes  small,  feeble, 
and  thready.  The  pupils  are  very  greatly  contracted.  The  power  of 
swallowing  is  gradually  lost,  the  pupils  become  insensible  to  light,  the 
muscles  relax,  and  the  patient  cannot  be  roused  from  this  state  of  pro- 
found insensibility.  Mucus  collects  in  the  throat,  and  at  last,  the 
breathing  ceasing,  death  takes  place.  Patients  may  die  in  a  state  of 
collapse,  and  not  from  asphyxia,  though  death  usually  happens  from 
l^aralysis  of  respiration. 

Sometimes  in  the  final  stages  of  opium-poisoning  breathing  stops  for 
a  time,  and  then  recommences,  and  this  alternation  is  repeated.  While 
breathing  the  pulse  is  frequent,  often  120  to  140.  When  respirations 
cease,  the  pulse  progressively  falls  in  frequency  till  it  reaches  80  or  90, 
and  after  a  time  suddenly  drops  perhaps  t^^enty  beats,  this  drop  preced- 


OPIUM.  4  i  O 

ing  always  the  recommencement  of  breathing,  and  after  two  or  three  res- 
pirations the  pulse  rapidly  rises  to  its  original  frequency.  Sometimes 
the  first  sign  of  recommencing  breutliing  is  a  slight  movement  of  the 
larynx.  Similar  changes  in  the  pulse  are  sometimes  observed  in  Chcyne- 
Stokes  breathing. 

In  opium  poisoning  a  variety  of  other  symptoms  occasionally  occur, 
as  diarrhoea,  diuresis,  convulsions  (most  common  in  children),  lockjaw, 
even  dilated  pupils,  sometimes  one  being  dilated  while  the  other  is  con- 
tracted, and  itching  and  dryness  of  the  skin. 

In  some  respects  opium  poisoning  simulates  apoplexy,  drunkenness, 
and  uraemic  coma. 

Opium  poisoning  may  be  generally  discriminated  from  apoplexy  by 
attention  to  the  following  points — history  of  the  attack,  odor  of  breath 
and  vomited  matters,  the  patient's  age,  and  the  state  of  the  pupils, 
which  in  apoplexy  are  very  generally  dilated,  and  are  very  often  unequal. 

Only  cases  of  profound  intoxication  put  on  a  superhcial  semblance 
of  opium  25oisoning.  In  each  case  there  is  great  insensibility.  If  the 
drunkard  can  be  roused,  he  answers  questions  incoherently;  but  if 
poisoned  by  opium,  although  he  is  slow  to  speak,  yet  his  answers  are 
rational  and  to  the  point.  The  breath  and  vomited  matters  will  very 
often  tell  if  alcoholic  drinks  have  been  taken ;  but  it  must  be  recollected 
that  suicides  by  laudanum  not  uncommonly  take  the  drug  in  beer  or 
other  drinks;  but  even  then  the  odor  of  the  laudanum  may  generally 
be  detected.  In  opium  poisoning  the  pupils  are  much  contracted,  but  in 
profound  drunkenness  the  puj)ils  are  widely  dilated.  Moreover,  the 
early  symptoms  of  the  attack  are  sufficient  to  ensure  discrimination 
between  opium  and  alcoholic  poisoning. 

Urgemic  coma  may  occur  very  suddenly  and  without  any,  or  scarcely 
any  dropsy.  To  distinguish  such  a  case  from  opium  poisoning  the 
history  of  the  attack  should  be  ascertained.  A  patient  in  ura^mic  coma 
can  generally  be  roused  partially,  Avhen  some  information  can  be  ex- 
tracted from  him.  An  analysis  of  the  urine,  moreover,  may  throw  much 
light  on  the  case,  while  the  state  of  the  pupils  precludes  suspicion  of 
poisoning  by  opium.  The  presence  of  a  hypertrophied  heart,  high 
tension  pulse,  with  a  small  quantity  of  albumen  in  the  urine  Avould 
show  that  the  patient  suffered  from  contracted  kidneys, — the  form  of 
kidney  disease  usually  producing  uraemia,  but  which  also  favors  cerebral 
haemorrhage. 

Effusion  of  blood  into  the  pons  varolii  will  produce  symptoms  almost 
identical  with  those  of  opium  poisoning;  thus  in  both  cases  there  is  jaro- 
found  insensibility,  with  closely  contracted  pupils,  and  slow  stertorous 
breathing.  It  may  be  impossible  to  discriminate  between  these  two 
conditions  till  a  posf-inorfeni  examination  reveals  the  real  cause  of  death. 

In  poisoning  by  opium  use  the  stomach  pump,  rouse  the  patient  and 
I'eep  liim  constanthj  moving,  to  prevent  sleep;  give  strong  coffee,  apply 
cold  affusion  to  tlie  head,  and,  if  necessary,  adopt  artificial  respiration. 

It  is  not  an  uncommon  practice  to  give  brandy  or  wine  to  a  patient 
recovering  from  the  effects  of  a  poisonous  dose  of  opium,  Avith  the  view 
of  overcoming  drowsiness;  but  having  watched  the  action  of  alcohol 
under  these  circumstances  I  always  found  that  it  greatly  increased  the 
sleepiness,  and  in  fact  did  harm. 

In  this  country  the  habit  of  opium  eating  is  not  so  largely  indulged 


414  OPIUM. 

in  as  among  Asiatics,  but  it  is  practiced  here  in  some  localities  to  a 
startling  extent.  It  is  taken  for  its  primary  stimulating  effect,  but 
after  a  time  increasing  doses  are  needed  to  produce  this  result.  Though 
carried  to  a  very  great  pitch,  opium-eating  in  some  individuals  induces 
neither  physical  nor  mental  weakness,  whilst  others  waste,  and  grow 
physically  and  mentally  weak,  irritable,  fretful  and  desponding,  especially 
when  the  opium  is  withheld;  the  memory  is  much  impaired;  the  skin 
becomes  shallow;  but,  strange  to  say,  in  many  cases  the  bowels  are  not 
constipated. 

The  horrors  which  opium-eaters  suffer  when  the  drug  is  withheld 
are  well  known,  and  need  not  be  dwelt  on  here;  so  great,  indeed,  is  the 
suffering,  that  few  have  sufficient  resolution  to  relinquish  the  habit. 
The  amount  of  opium  taken  is  often  enormous.  De  Quincey  took  3::i0 
grains  daily  !  Moderate  indulgence  of  the  habit  is  perhaps  not  more 
prejudicial  to  health  than  tobacco-smoking. 

Barnard's  experiments  led  him  to  conclude  that  opium  depresses 
the  functional  activity  of  the  sympathetic  system,  and  notably  that  part 
supplying  the  submaxillary  gland.  Gscheidlen  considers  that  opium 
affects  the  terminations  of  "the  motor  nerves;  small  doses  at  first 
heightening  but  afterwards  depressing  their  function,  whilst  largedoses 
depress  it  from  the  first.  Opium  is  said  to  lessen  the  conductivity  of 
sensory  nerves,  though  this  blunted  sensibility  must  be  due  in  some 
measure  to  the  effect  of  opium  on  the  gray  matter  of  the  brain,  depress- 
ing the  power  of  perception. 

In  the  course  of  fevers,  specific  or  inflammatory,  soporifics,  and  above 
all  others  opium,  are  often  of  the  greatest  value.  Some  patients  first 
show  signs  of  failing  in  the  nervous  system ;  and  this  depression  of  the 
nervous  system  is  generally  due  to  want  of  sleep.  From  sleeplessness 
the  nervous  system  becomes  exhausted  and  the  patient  wanders.  If  sleep 
does  not  occur  spontaneously,  or  is  not  induced  by  drugs,  the  delirium 
becomes  more  marked  and  may  be  violent,  as  is  often  the  case  with 
typhus,  or  muttering,  as  in  typhoid  fever.  With  the  still  further  ex- 
haustion of  the  nervous  system  there  arises  the  trembling  movements  of 
the  extremities  or  of  the  protruded  tongue,  and  the  muscles  tAvitch. 
The  tongue  becomes  dry;  appetite,  digestion,  and  assimilation  become 
depressed.  With  this  nervous  exhaustion,  even  if  the  heart's  action  has 
for  some  time  remained  good,  cardiac  exhaustion,  shown  by  a  frequent 
and  feeble  pulse,  soon  sets  in;  and  henceforth  the  patient  is  in  a  highly 
critical  condition.  If  laudanum  is  given  early,  and  before  much  nervou-s 
exhaustion  occurs,  refreshing  sleep  is  induced  and  the  nervous  system  is 
sustained;  hence  the  need  of  stimulants  is  avoided  or  much  lessened. 
Ten  or  fifteen  drops  of  laudanum  is  generally  sufficient,  but  its  action 
is  made  much  more  certain  by  the  addition  of  ten  or  fifteen  grains  of 
chloral. 

It  may,  however,  happen  that  the  opportunity  of  warding  off  nervous 
weakness  is  lost,  and  the  patient  has  become  very  delirious.  Where  the 
delirium  is  of  the  furious  kind  it  is  well  to  combine  the  opium  with 
tartar-emetic,  as  this  combination  calms  the  excitement  and  produces 
sleep  more  speedily  and  effectually  than  opium  given  alone.  Graves 
gave  three  or  four  drops  of  laudanum,  and  one-sixth  to  one-eighth  of  a 
grain  of  tartar -emetic  every  two  hours  till  tranquillity  and  sleep  were 
ensured;  in  very  boisterous  delirium  he  increased  the  dose  of  tartar- 
emetic.     If  the  delirium   is  of  the  muttering  kind,  laudanum  either 


OPIUM.  415 

alone  or  combined  with  chloral  is  preferable.  The  h5'podermic  injection 
of  morphia  often  succeeds  in  such  cases.  The  good  effect,  too,  of  opium 
is  well  shown  in  cases  of  marked  nervous  exhaustion.  A  slee^^less  patient 
with  twitching  and  tremor  of  the  muscles,  quivering,  dry,  brown  tongue 
and  parched  skin,  with  rapid  and  feeble  pulse,  after  a  dose  of  laudanum 
falls  into  a  sleep  of  several  hours;  the  delirium  abates  or  disappears,  the 
twitching  and  quivering  of  the  muscles  becomes  much  less,  the  tongue 
becomes  moist,  the  appetite  improved,  and  the  pulse  stronger  and  less 
frequent;  and  with  a  nightly  use  of  laudanum  this  improvement  is 
sustained. 

Laudanum,  by  inducing  sleep,  greatly  lessens  the  amount  of  alcohol 
Avhich  otherwise  would  be  required,  and  if  the  laudanum  is  given  early, 
alcohol  is  not  often  needed. 

The  cases  I  have  here  dejiicted,  where  the  weakest  resistance  is  in 
the  nervous  system,  contrast  strikingly  with  another  class  of  cases  where 
the  resistance  is  least  in  the  heart,  and  this  organ,  instead  of  the  nervous 
system,  primarily  yields.  In  such  a  case  we  get  signs  of  danger  in  the 
frequent  and  feeble  pulse;  and  this  may  occur  whilst  general  strength 
appears  good,  the  voice  strong,  aj^petite  and  digestion  fair,  and  whilst 
there  is  no  delirium.  Where  the  heart  failure  occurs  early,  opium  is 
of  little  use,  and  alcohol  is  required.  In  such  a  case  digitalis  is  often 
very  serviceable,  slowing  the  heart  and  sustaining  its  strength  and  so 
obviating  the  need  of  much  alcohol.  Quinine  with  digitalis  is  also 
useful  in  the  case  just  described. 

In  deliriuiti  tremens  opium  does  good  service  by  producing  sleep, 
and  it  answers  best  when  employed  hypodermically.  If  the  patient-  is 
strong,  the  delirium  boisterous,  the  pulse  full,  tartar-emetic  or  tincture 
of  aconite  may  be  added  to  the  opium.  It  is  convenient  to  administer 
the  opiate  with  j^orter  or  spirits,  this  combination  apj^arently  heighten- 
ing its  action,  while  it  is  more  readily  taken  by  the  delirious  patient. 
It  has  been  already  mentioned  that  opium  in  delirium  tremens  some- 
times acts  more  efficiently  when  given  by  the  rectum. 

It  is  still  better  to  employ  it  hypodermically.  In  delirium  tremens 
it  is  well  known  that  the  effects  of  opium  vary  greatly,  a  moderate  dose 
even  sometimes  producing  a  fatal  sleep.  This  variable  effect  often 
depends  on  the  condition  of  the  kidneys.  These  are  often  diseased  in 
drunkards  and  tipplers.  In  Bright's  disease  it  is  necessary  to  give  opium 
with  caution,  not  that  the  disease  contra-indicates  it;  on  the  contrary, 
it  is  often  useful;  but  in  Bright's  disease  the  opium  acts  often  with 
unusual  power;  thus,  in  this  disease,  it  must  at  first  be  given  in  a  small 
dose  to  test  its  effect.  Hence,  in  delirium  tremens,  before  giving  opium 
or  morphia,  the  urine  should  be  tested  for  albumen. 

Many  cases  of  acute  mania  may  likewise  be  treated  satisfactorily  by 
opium  and  tartar-emetic.     (See  Ciiloral.) 

Scanzoni  finds  the  hypodermic  injection  very  useful  in  nrtemic  con- 
vulsions. 

Dr.  Anstie  strongly  insisted  that  opium  acts  chiefly  in  virtue  of  its 
stimulating  action,  and  that  as  a  stimulant  it  relieves  neuralgia,  and  that 
it  is  not  necessary  to  give  narcotic  but  only  stimulant  doses.  This  view 
has  lately  been  urged  by  Dr.  Pope,  of  New  Orleans,  who  attributes  the 
usefulness  of  opium  in  fevers  with  great  prostration  to  the  stimulating 
action  of  opium,  and  not  to  its  producing  sleep.  He  recommends  the 
hypodermic  use  of  morphia  in  the  debility  consequent  on  onanism.     I 


416  OPIUM. 

have  often  seen  morphia,  given  hypodermically,  useful  in  cases  of  the 
follo'ving  kind: — An  hysterical  patient  suffers  acutely  from  flitting  neu- 
ralgia, attacking  now  one  nerve,  and  speedily  seizing  on  another,  and  so 
forth.  She  is  greatly  depressed  mentally  and  physically.  The  hypoder- 
mic injection  of  morphia  sends  a  glow  throughout  the  body,  reaching  even 
the  fingers  and  toes,  and  the  cold  extremities  at  once  become  warm,  the 
neuralgic  pains  disappear,  and  the  mind  and  body  become  invigorated, 
and  these  effects  last  several  hours.  Again,  I  have  seen  the  hypoder- 
mic injection  of  great  comfort  in  cases  of  this  kind: — A  man  suffers  from 
melancliolia,  is  disinclined  to  exercise,  and  has  loss  of  appetite.  After 
an  injection  the  depression  of  sprits  clears  off  like  a  thick  cloud,  the  pati- 
ent becomes  cheerful  and  chatty,  the  appetite  returns,  and  he  is  able  to 
take  a  long  walk  without  fatigue.  In  such  cases,  no  doubt,  we  see  the 
stimulating  action  of  the  opium;  but  this  result  always  appears  to  me  to 
depend  on  an  idiosyncrasy,  and  not  on  the  nature  of  the  disease;  that 
these  effects  occur  in  those  who  obtain  only  the  soothing  and  delicious 
effects  of  opium;  for  in  other  patients  with  the  same  symptoms  the  hypo- 
dermic injection  of  morphia  fails  to  relieve  anything  but  the  pain,  or  may 
even  produce  great  depression,  and  very  uncomfortable  symptoms  It 
appears  to  me,  therefore,  that  the  stimulating  action  depends  chiefly  on 
an  idiosyncrasy  of  the  patient,  and  in  cases  of  prostration  in  fever  I  attrib- 
ute the  good" effects  of  opium  far  more  to  the  soothing,  strengthening 
effects  of  the  sleep  than  to  the  stimulating  action  of  the  opium;  a  conclu- 
sion confirmed  by  the  fact  that  good  results  do  not  generally  follow  unless 
the  opium  produces  sleep. 

Dr.  Graves  has  well  pointed  out  that  when  an  opiate  is  given  as  an 
hypnotic  attention  should  be  paid  to  the  time  of  its  administration.  It 
should  be  given  at  the  usual  time  for  sleep,  or  when  the  patient  feels 
inclined  to  doze,  so  that  the  medicine  may  come  in  aid  of  nature;  smaller 
doses  are  then  more  effectual  than  if  given  at  a  less  seasonable  time. 
From  example,  in  chronic  wasting  disease,  accompanied  with  hectic,  the 
opiate  should  be  given  very  late  at  night;  for  with  hectic  there  is  often 
no  inclination  to  sleep  till  the  early  morning  hours.  Opium  ordinarily 
requires  about  one  or  two  hours  to  produce  its  narcotic  effects.  Chronic 
sleeplessness,  independent  of  any  very  notable  disease,  should  not  be 
treated  with  opium  if  it  is  possible  to  avoid  it.  Dyspepsia  and  uterine 
derangements  are  constant  causes  of  sleeplessness,  and  chloral  and  bromide 
of  potassium  are  much  better  agents  than  opium. 

Opium  will,  of  course,  relieve  or  abolish  pain;  yet  in  the  treatment  of 
chronic  cases  it  is  right  first  to  exhaust  all  other  methods,  for  the  opiate 
soon  loses  its  influence,  and  must  be  given  in  increasing  quantities,  i;ntil 
the  patient  becomes  accustomed  to  it,  and  is  unable  to  discontinue  it  with- 
out great  discomfort,  even  after  permanent  removal  of  the  pain. 

Opium,  especially  when  employed  hypodermically,  often  relieves  pain, 
and  ensures  sleep  in  acute  rheumatism. 

Ojiium  is  often  of  signal  use  as  an  anti-spasmodic.  Its  action  in  this 
respect,  as  well  as  its  narcotic  power,  is  much  enhanced  if  given  with  a 
stimulant,  as  alcohol,  ether,  or  chloroform. 

Laudanum  or  morphia  is  of  marked  service  in  the  convulsive  stage  of 
whooping-cough.  A  sufficient  dose  should  be  given  to  a  child  to  produce 
very  slight  heaviness,  which  state  should  be  maintained  by  giving  one-fif- 
tieth of  a  grain  of  morphia  every,  three  or  four  hours,  or  a  proportionate 
dose  every  hour.     A  quarter  of  a  drop,  or  two  drops  of  laudanum,  accord- 


OPIUM.  417 

ing  to  tlie  age  of  the  child,  must  be  given  every  hour.  This  treatment 
often  quickly  removes  the  whoop,  and  reduces  the  severity  and  frequency 
of  the  cough;  but  in  the  case  of  an  irritation,  as  of  teetliing,  or  of  worms, 
tuberculosis,  or  much  bronchitis,  this  remedy,  like  most  others,  is  of  little 
or  no  use. 

Opium  and  its  preparations  are  beneficial  in  renal  and  biliary  colic. 
Morphia  answers  best  when  employed  hypodermically.  If  administered 
by  the  mouth,  small  doses  of  the  opiate,  combined  with  spirits  of  chloro- 
form, should  be  administered  every  five  or  ten  minutes,  till  the  pain  gives 
way. 

Opiates  are  also  beneficial  in  cases  of  asthma,  yet  with  some  asthmatics 
morphia  will  induce  a  paroxysm  of  dyspnoea. 

Opium  is  very  useful  in  diabetes,  to  control  inordinate  appetite;  the 
diminution  of  quantity  of  ingested  food  reduces  the  kidney  secretion,  and 
abates  the  troublesome  thirst.  It  was  at  one  time  thought  that  this  was 
the  only  way  opium  proved  useful  in  diabetes,  but  it  has  been  lately  shown 
that  large  doses,  frequently  repeated,  will  greatly  lessen,  and,  indeed, 
remove  the  sugar  from  the  urine,  the  diet  and  the  appetite  remaining 
unchanged. 

Opiates  are  also  used  in  spasmodic  stricture. 

Opium  and  its  preparations  are  reputed  to  check  the  excretion  from 
all  the  mucous  membranes  of  the  body,  and  on  this  account  are  given  in 
bronchitis  to  check  excessive  secretion  of-  mucus  and  pus. 

Opiates  are  employed  as  diaphoretics. 

Ten  grains  of  Dover's  powder  at  bedtime  will  generally  check  the 
night  sweats  of  phthisis,  and  other  exhausting  diseases,  even  when  other 
remedies,  like  zinc,  have  failed. 

It  is  well  known  that  opium,  in  a  small  dose  taken  at  night,  if  resorted 
to  at  the  commencement  of  the  attack,  will  cut  short  a  cold  in  the  head. 
Some  attribute  its  efficacy  to  its  influence  on  the  skin;  and  Dover's  pow- 
der is  very  generally  employed.  Two  or  three  drops  of  laudanum,  taken 
at  bedtime,  is  often  sufficient  at  once  to  abolish  a  threatening  attack  of 
cold  in  the  head.     A  glass  of  hob  grog  assists  the   action  of  the  opium. 

Laudanum,  especially  when  mixed  with  tincture  of  nux  vomica,  is 
very  serviceable  in  some  of  the  distressing  symptoms  which  afflict  hysteri- 
cal women,  or  nervous,  overworked,  anxious  men.  Both  men  and  women, 
but  .chiefly  women  about  forty  or  fifty  years  of  age,  are  apt  to  complain  of 
a  sensation  of  great  weight  and  heat  on  the  top  of  the  head,  with  frequent 
flushings  of  the  face,  suffusion  of  the  eyes,  hot  and  cold  perspirations, 
and  sometimes  shooting  pains  passing  up  the  back  of  the  head.  The  pain 
occasionally  centres  in  one  brow,  with  much  heaviness  and  torpor  after 
meals,  and  now  and  then  the  sensation  as  of  a  tight  cap  on  the  vertex,  or 
dull  aching  pain  in  the  same  part,  with  inability  to  fix  the  attention,  and 
much  depression  of  spirits.  These  symptoms  may  generally  be  traced  to 
a  variety  of  causes,  as  d;^'spepsia,  especially  the  flatulent  form,  heartburn, 
uterine  derangements  of  various  kinds,  or  unhygienic  conditions.  In  any 
case,  however,  a  drop  of  laudanum,  with  two  of  the  tincture  of  nux  vom- 
ica, repeated  three  or  four  times  a  day,  will  generally  dissociate  the  fore- 
going symptoms  from  the  disease  with  which  they  are  connected,  to  the 
great  relief  of  the  patient. 

Morphia  occasionally  produces  an  eruption,  sometimes  like  that  of 
measles,  at  other  times  like  that  of  nettlerash.  It  maybe  accompanied  by 
distressing  itching,  sufficient  often  to  counteract  the  anodyne  properties  of 
the  medicine.  27 


418  opirM. 

Tincture  of  0]->ium  in  a  large  dose  (  3  j).  mixed  with  brandy,  is  recom- 
mended in  ])rofuse  flooding  iifter  parturition,  accompanied  with  much 
exhaustion  of  the  uterus. 

The  influence  of  opiates  on  the  urine  of  diabetes  has  already  been 
pointed  out. 

The  i)reparations  of  opium  diminish  the  water  and  urea  of  healthy 
urine,  probably  by  lessening  the  appetite  and  hindering  digestion.  Mor- 
phia passes  partly  away  by  the  urine. 

Under  the  influence  of  opium  the  urine  is  sometimes  retained  for  sev- 
eral days  in  the  bladder. 

It  is  important  to  bear  in  mind  that  the  active  principles  of  opium 
pass  out  with  the  milk,  so  that  a  child  at  the  breast  may  be  dangerously 
affected  by  opium  given  to  its  mother. 

Individual  peculiarity,  disease,  age,  custom,  sex,  modify  the  action  of 
opium. 

We  have  already  spoken  of  individual  peculiarity.  Mr.  J.  Brown  has 
shown  that  there  is  sometimes  hereditary  susceptibility  to  some  drugs,  as 
opium  and  mercury. 

As  is  well  known,  very  large  doses  are  tolerated  in  some  diseases, 
especially  in  the  cases  of  severe  pain. 

Age  influences  the  action  of  all  medicines,  but  in  an  especial  degree 
that  of  opium.  That  a  dose  of  a  medicine  should  act  far  more  powerfully 
on  the  young  than  the  old  is  only  natural,  for  as  it  becomes  mixed  and 
diluted  with  the  blood  the  dilution  is,  of  course,  greater  in  adults  than  in 
children.  Other  things  being  equal,  the  dose,  as  a  general  rule,  mast  be 
proportioned  to  the  weight  of  the  individual,  provided  there  is  no  undue 
development  of  fat.  Opium,  however,  is  a  notable  exception,  the  relative 
susceptibility  of  young  children  to  its  action  being  far  greater  than  in 
adults.  So  great  is  the  power  of  opium  over  individuals  of  tender  years 
that  great  care  must  be  taken  in  its  administration. 

The  influence  of  custom  on  the  action  of  opium  has  already  been 
mentioned. 

Opium,  it  is  said,  affect  women  more  readily  than  men,  particularly  as 
regards  its  exciting  effects. 

Morphia  is  said  to  be  less  stimulating,  less  constipating,  less  diapho- 
retic, and  less  liable  than  opium  to  produce  headache  and  nausea. 

Some  writers  extol  the  narcotic  virtues  of  codeia,  asserting  that,  unlike 
opium,  it  produces  calm  sleep  without  disordering  digestion,  exciting 
nausea,  constipation,  or  producing  headache;  other  observers,  however, 
consider  it  useless  as  a  narcotic. 

Karcein  has  been  much  recommended  as  a  hypnotic  and  sedative.  It 
is  said  to  be  more  efficacious  than  morjihia,  and  to  produce  no  lieadache, 
to  induce  less  perspiration,  not  to  constipate,  nay,  in  largo  doses  to  purge, 
rarely  exciting  vomiting,  but  often  nausea  and  loss  of  appetite.  One 
observer  computes  that  narcein  is  four  tnnos  Aveaker  than  morphia.  It  is 
stated  that  narcein  is  the  only  alkaloid  of  opium  which  does  not  produce 
convulsive  movements. 

Dr.  J.  Harley  considers  narcein  a  pure  hypnotic,  much  feebler  than 
mor]ihia,  and  of  very  little  use  in  medicine,  its  insolubility  rendering  it 
unfit  for  subcutaneous  injection.  On  the  other  hand,  having  tested  it  by 
mouth  and  hypodermically  Dr.  Fronmiiller  asserts  that  narcein  possesses 
no  narcotic  properties,  a  dose  of  20  grains  by  the  stomach  producing  no 
sleepiness  or  any  effect  on  the  respiration,  pulse,  heat  of  skin,  urine, 
or  pu})ils. 


NUX    VOMICA.  419 

Narcotine,  in  doses  of  one  to  three  grains,  is  asserted  to  possess  anti- 
periodic  properties,  some  considering  it  even  superior  to.qninia  in  ague. 

Very  conflicting  statements  are  made  regarding  other  properties  of 
narcotine.  Eulenberg,  Charvet,  Fronmiiller,  and  others,  assert  that  small 
doses  increase  the  frequency  and  the  strength  of  the  pulse,  but  after  a 
time  make  it  irregular,  and  that  it  increases  the  frequency  of  the  respira- 
tions and  exalts  the  temperature.  Small  doses  they  say  are  not  narcotic. 
Schrolf  says  doses  of  0.06  to  0,12  grm.  produce  symptoms  like  the  first 
stage  after  a  usual  dose  of  opium,  but  without  affecting  the  pupil  or  pro- 
ducing nausea.  Fronmiiller  asserts  that  15  to  30  grains  produce  sleep, 
but  Bailey  gave  60  to  120  grains  without  inducing  sleep. 

Papaverine  is  said  to  possess  strong  narcotic  properties  without  induc- 
ing the  ])revious  stages  of  excitement,  and  is  not  folloAved  by  headache 
and  giddiness.  It  contracts  the  pupil,  and,  when  it  causes  sleep,  reduces 
considerably  the  frequency  of  the  pulse,  to  the  extent  even  of  twenty  to 
thirty  beats.  Fronmiiller  also  finds  that  it  is  a  narcotic,  and  that  it  dila- 
tes the  pupil — the  pulse,  respiration,  and  temperature  remaining  unal- 
tered. Hoffman,  in  some  experiments  on  himself,  could  not  obtain  these 
results. 

The  statements  concerning  the  action  of  the  opium  alkaloids  are  most 
contradictory,  due  probably  in  part  to  the  use  of  impure  preparations, 
or  to  the  employment  of  a  mixture  of  the  alkaloids,  or  in  part  to  the  fact 
that  the  action  of  these  substances  on  animals  is  different  to  their  effect 
on  man.  Thus,  as  regards  man,  morphia  is  the  most  powerful  alkaloid; 
but  according  to  Bernard,  as  regards  animals  it  ranks  fourth.  Thebaia 
is  to  animals  the  most  poisonous  alkaloid,  but  its  effect  on  man  is  much 
less  marked;  again,  it  is  said  that  with  respect  to  animals  narcein  is  the 
most  soporific  of  the  alkaloids,  but  its  action  on  man  is  far  less  than  that 
of  morphia. 


NUX  VOMICA.     STRYCHNIA.     BRUCIA.     THEBAIA. 

The  three  alkaloids,  strychnia,  brucia,  and  thebaia,  ajipear  to  exert 
a  similar  action  on  the  spinal  cord,  so  that,  for  convenience  sake,  they 
are  grouped  together;  but  it  should  be  stated  that  strychnia  is  more 
powerful  than  brucia,  and  brucia  than  thebaia.  Our  succeeding  remarks 
aj^ply  mainly  to  nux  vomica  and  its  alkaloids,  as  thebaia  has  not  yet  been 
put  to  any  therapeutic  application. 

The  late  Dr.  Anstie  recommended  the  hypodermic  injection  of 
strychnia,  in  one-hundred-and-twentieth  of  a  grain  doses,  to  relieve  the 
pain  of  cardialgia  and  gastrodynia.  "  There  is,"  he  says,  "  no  such 
remedy  for  gastralgia  as  this." 

Mr.  Charles  Hunter  advises  the  injection  of  strychnia  hypodermically 
in  cerebral,  spinal,  and  other  forms  of  parah'sis.  About  one-eightieth 
to  one  sixtieth  of  a  grain,  administered  twice  or  three  times  a  week, 
will,  he  says,  after  three  or  four  injections,  almost  always  show  if 
strychnia  manifests  any  effect  on  that  jiarticular  form  of  palsy.  The 
injection  produces  a  general  warmth  or  glow  of  the  skin  lasting  a  few 
hours,  felt  most  in  the  paralyzed  limbs,  and  down  the  spine;  it  removes 
the  sensation  of    heaviness,  or  weight,  and  the   muscular    twitchings. 


420  NUX    VOMICA. 

spasms,  or  cramps,  and  may  induce  sweating,  especially  of  the  i^alsied 
parts.     Most  of  these  results  I  have  myself  witnessed. 

Hypodermic  injections  progressively  increased,  till  even  one-twelfth 
of  a  grain  is  injected  at  one  dose  daily,  are  useful  in  essential  jjaralysis 
of  children  and  in  diphtheritic  paralysis. 

Dr.  Julian  Chesolm  employs  h^-^^odermic  injections  of  strychnia  in 
eye  and  ear  diseases,  beginning  with  one-fortieth  of  a  grain  daily,  increas- 
ing the  quantity  till,  in  fifteen  to  twenty  days,  one-sixth  or  one-fifth  of  a 
grain  is  reached,  and  no  benefit  may  take  place  till  these  larger  doses  are 
administered.  As  we  meet  with  idiosyncrasies  in  respect  of  strychnia,  it 
is  well  to  begin  with  a  small  dose.  He  employs  these  injections  in  mus- 
cular asthenopia,  amblyoj^ia,  tobacco  amaurosis,  and  in  progressive  nerve 
atrophy  not  dependent  on  intra-cranial  disease.  Dr.  Werner  finds  strych- 
nia by  injection  useful  in  traumatic  amaurosis.  Perhaps  these  large 
doses  given  by  the  stomach  might  prove  just  as  serviceable. 

The  preparations  of  nux  vomica  have  an  intensely  bitter  taste,  and, 
like  other  bitters,  augment  the  flow  of  saliva. 

They  produce  a  sensation  of  hunger,  but  there  is  no  evidence  that,  in 
a  healthy  person,  either  strychnia  or  any  other  bitter  substance  increases 
the  digestive  power.  Like  other  bitters,  and,  perhaps,  in  a  greater 
de^'ee,  these  preparations,  by  their  slight  irritant  action,  check  unhealthy 
deviations  of  the  gastric  mucous  membrane,  and  may  in  this  way  promote 
digestion.  The  action  of  bitters,  and  especially  of  the  tincture  of  nux 
vomica,  far  the  best  and  most  agreeable  agent  for  this  purpose,  is  well 
shown  in  certain  perverted  conditions  of  the  digestive  canal.  For  exam- 
ple, in  the  course  of  chronic  diseases,  such  as  bronchitis,  dilated  heart,  or 
cirrhosis  of  the  liver,  the  tongue  not  unfrequently  becomes  thickly  coated 
with  a  white  fur,  and  the  symptoms  indicate  chronic  catarrh  of  the 
stomach:  one  or  two  drops  of  the  tincture  of  nux  vomica  in  a  teaspoonful 
of  water,  every  two  hours,  or  of tener,  for  twenty-four  to  forty-eight  hours, 
will  often  clean  the  tongue,  improve  the  digestion,  and,  at  a  critical  time, 
clear  the  way  for  the  administration  of  nourishment.  Again,  during  early 
convalescence,  Avhen  the  tongue  still  continues  coated,  and  the  digestion 
weak,  nux  vomica  will  prepare  the  way  for  stronger  tonics  and  more  liberal 
diet. 

This  treatment  greatly  mitigates  the  annoying  flatulence  and  indiges- 
tion occurring  in  cases  of  mechanical  obstruction  of  the  circulation  in 
the  digestive  organs,  as  from  cirrhosis  and  dilated  heart;  indeed,  nux 
vomica  is  more  or  less  serviceable  in  flatulency  of  any  kind.  Heartburn 
also  frequently  yields  to  small  quantities  of  the  tincture,  given  three  or 
four  times  a  day. 

TTux  vomica  is  of  great  service  in  a  group  of  symptoms,  including 
weight  at  the  pit  of  the  stomach  after  food,  acidity,  and  heartburn;  flatu- 
lence, accompanied  by  heat  and  weight  at  the  top  of  the  head,  the  last 
symptom  occurring  usually  in  woman,  especially  about  middle  age.  This 
dyspeptic  condition  is  often  benefited  by  five  drops  of  the  tincture  of  nux 
vomica  taken  about  a  quarter  of  an  hour  before  food,  three  times  a  day. 
The  heat  and  sensation  of  weight  on  the  top  of  the  head,  even  when  oc- 
curring independently  of  any  gastric  disturbance,  often  yields  to  the  same 
treatment. 

In  acute  gastric  catarrh,  accompanied  by  *'sick  headache."  the  action 
of  tincture  of  nux  vomica  is  sometimes  very  marked.  This  common  and 
troublesome  complaint  is  sometimes  traceable  to  error  in  diet,  or  consti- 


NUX    VOMICA.  421 

pation,  but  it  occurs  often  without  any  apparent  cause.  Headache  is  often 
the  most  prominent  symptom,  the  nausea  being  very  slight,  amounting 
to  mere  qualmishness.  A  drop  of  the  tincture  in  a  teaspoonful  of  water, 
taken  every  five  or  ten  minutes,  to  the  extent  of  eight  to  ten  doses,  and 
then  continued  at  longer  intervals,  often  quickly  mitigates,  and  in  a  few 
hours  removes,  this  kind  of  headache,  which  otherwise  would  continue 
all  the  day. 

The  tincture  or  extract  of  nux  vomica  has  long  been  employed  to 
correct  constipation,  habitual  or  temporary.  The  extract,  mixed  with 
otlier  remedies,  such  as  rhubarb  or  colocynth  pill,  should  be  taken  daily 
shortly  before  dinner,  to  aid  digestion,  and  the  proper  unloading  of  the 
bowels.  The  same  effect  may  often  be  obtained  by  giving  one  or  two 
drops  of  the  tincture  twice  or  three  times  a  day.  As  our  knowledge  of 
the  action  of  nux  vomica  in  its  relation  to  constipation  is  at  present  im- 
l)erfect,  the  results  appear  to  be  capricious.  It  is  as  well,  therefor^?,  not 
to  be  too  sanguine  of  success;  for  in  some  cases  it  answers  beyond  all  ex- 
pectation, while  in  other  apparently  similar  cases  it  completely  fails.  If 
the  bowels  are  habitually  sluggish,  the  patient  should  take  occasionally, 
early  in  the  morning,  half  a  tumblerful  of  some  natural  purgative  water  to 
assist  the  nux  vomica.  Should  the  tardy  action  be  due  to  insufficient 
supply  of  bile,  the  motions  being  pale  in  color,  nux  vomica  will  fail,  and 
other  medicines  are  required. 

Strychnia,  as  Mr.  Savoy  has  shown,  is  much  more  poisonous  when  in- 
jected into  the  rectum  than  when  swallowed,  a  curious  difference,  not  due 
to  the  digestion  and  destruction  of  the  alkaloid  by  the  gastric  juice,  since 
Mr.  Savoy  has  proved  that  this  secretion  exerts  very  little,  and  probably 
no  effect,  upon  strychnia. 

Strychnia,  another  active  principle  of  nux  vomica,  quickly  enters  the 
blood,  as  is  shown  by  the  rapidity  with  which  a  poisonous  dose  is  followed 
by  characteristic  symptoms.  Moreover,  the  alkaloid  can  be  extracted  from 
the  blood  and  urine,  a  conclusive  proof  of  its  absorption. 

A  large  and  poisonous  dose  produces  symptoms  very  closely  resembling 
those  of  tetanus.  Symptoms  usually  come  on  in  twenty  minutes  to  half 
an  hour,  and  are  rarely  delayed  beyond  an  hour.  The  first  symptoms  are 
general  uneasiness,  with  restlessness  and  soreness  of  the  limbs.  Shooting 
pains  like  electric  shocks  occur  in  various  parts  of  the  body,  often  first  in 
the  back,  and  down  the  arms  and  legs.  Tetanic  and  paroxysmal  contrac- 
tion of  the  muscles  soon  sets  in,  and  these  symptoms  grow  rapidly  worse, 
and  make  the  body  rigid  while  the  paroxysm  lasts.  The  first  paroxysm, 
may  be  very  severe.  The  respiratory  movements  are  completely  arrested, 
so  that  the  face  becomes  bloated  and  livid,  the  jugular  veins  stand  out  in 
the  neck,  the  eyes  are  staring  and  prominent,  the  jaws  firmly  clenched, 
and  the  pupils  dilated.  Each  spasmodic  attack  lasts  from  a  few  seconds 
to  a  minute  or  more,  and  then  generally  ceases  altogether  for  a  time. 
Throughout  the  paroxysms,  the  mind  is  quite  unaffected,  and  the, patient's 
sufferings  are  agonizing.  A  breath  of  air,  a  slight  noise,  movement  of 
the  bed-clothes,  the  most  trivial  cause,  will  excite  tetanic  spasms.  In  a 
fatal  case  death  is  rapid;  but  if  the  patient  should  survive  two  or  three 
hours,  sanguine  hopes  may  be  entertained  of  his  recovery.  A  fatal  ter- 
mination may  be  due  either  to  exhaustion  from  the  repeated  convulsions, 
or  to  asphyxia  from  spasms  of  the  muscles  of  the  chest.  The  muscles  of 
the  jaw  are  usually  the  last  to  be  affected. 


422  Nux  VOMICA. 

Brncia,  tliebaia,  and  most  of  the  opium  alkaloids  affect  the  body  in 
the  same  way. 

The  symptoms  of  strychnia  poisoning  differ  from  those  of  tetanus  in 
the  following  particulars: — From  the  first  the  poison  symptoms  are  very 
strongly  marked  and  raj)idly  reach  their  worst,  perfect  intermissions  occur, 
and  death  soon  takes  place;  or  the  symptoms  rapidly  decline,  and  the 
patient  recovers.  Fatal  doses  of  strychnia  raise  the  temperature  of  dogs 
from  4°  to  6°  Fah. 

Treatment  of  poisoning: — Stomach  ptwip,  if  available  in  time,  for  after 
tetanic  symptoms  have  set  in  the  introduction  of  the  tube  would  excite  a 
paroxysm.  Animal  charcoal.  Tannin  solution  of  iodine.  Chloroform 
inlialation.  Injection  of  curare,  or  of  methyl  and  ethyl  compounds  of 
strychnia,  of  brucia,  or  of  thebaia.     Artificial  respiration.     Fats. 

Leube  and  Rosenthal  find  that  pulmonary  insufflation  arrests  strychnia 
tetanus  by  increasing,  as  they  supposed,  the  absorption  of  oxygen.  Brown- 
Sequard  confirms  tliese  statements  concerning  insufflation,  but  contends 
that  the  arrest  of  convulsions  is  due  to  the  mechanical  effect  produced  Ijy 
the  forcible  impact  of  the  air  upon  the  ramifications  of  the  vagus,  of  the 
bronchi,  and  of  the  nerves  of  the  diaphragm,  exciting  a  reflex  inhibitory 
action;  for  section  of  the  cord  above  or  below  the  origin  of  the  phrenic 
nerves  and  section  of  the  vagi  prevent  the  action  of  insufflation. 

Strvchnia  excites  tetanus,  not  through  the  brain;  for  in  poisoning  by 
strychnia,  the  mind,  to  the  last,  remains  unaffected,  and  between  the 
paroxysms  animals  can  execute  voluntary  movements.  Xor  does  it  teta- 
nize  through  the  muscles  or  nerves;  for  after  division  of  one  sciatic  nerve, 
strychnia  excites  tetanus  in  every  part  of  the  body  except  in  the  limb  sup- 
plied by  the  divided  nerve;  yet  as  the  vessels  of  this  limb  are  undivided, 
its  convulsed  muscles  and  nerves  are  as  much  poisoned  by  strychnia  as 
those  parts  which  are  convulsed.  As  strychnia  tetanizes  neither  through 
the  brain,  muscles  nor  nerves,  it  must  act  through  the  cord.  This  con- 
clusion is  confirmed  by  the  following  experiments:  1.  If  the  cord  and  all 
the  vessels  supplying  its  posterior  part  are  cut  and  the  animal  is  then 
poisoned,  convulsions  occur  in  the  anterior  portion  of  the  body,  but  simple 
normal  reflex  acts  follow  stimulation  of  the  posterior  part  of  the  body, 
that  part  indeed  under  the  control  of  the  division  of  tbe  cord  protected 
from  the  poison  by  secretion  of  its  vessels.  '2.  If  all  the  blood  is  allowed 
to  drain  from  the  body  of  a  frog  by  section  of  its  heart,  and  a  small  quan- 
tity of  strychnia  is  then  placed  on  the  forward  part  of  the  cord,  the  anterior 
parts  of  the  body  become  speedily  tetanized,  and  this  condition  slowly 
extends  to  the  posterior  parts  as  the  strychnia  descends  and  affects  the 
rest  of  the  cord. 

Dr.  G.  Walton  finds  that  strychnia,  in  a  dose  sufficient  to  produce 
tetanus,  so  affects  the  cord  that  any  stimulus  capable  of  producing  a 
reflex  contraction  produces  a  maximal  contraction,  provided  a  certain  time 
has  elapsed  since  the  preceding  stimulation.  The  necessary  interval  varies 
with  the  degree  of  poisoning,  being  a  few  seconds  only  when  the  frog  is 
strongly  poisoned.  During  this  interval  the  degree  of  contraction  depends 
on  the  strength  of  the  stimulus.  All  the  contractions  are  tetanic.  After 
strvchnia  there  is  no  summation  of  stimuli,  the  behavior  of  the  strvchnized 
cord  thus  differing  strikingly  from  the  unpoisoned  cord.  The  minimjil 
stimulus,  capable  of  producing  a  reflex  movement,  becomes  less  and  less 
as  the  poisoning  effect  increases.  The  motor  and  sensory  nerves.  Dr. 
AValton  finds,  are  unaffected  by  strychnia. 


NUX   VOMICA.  423 

After  traumatic  and  strychnia  tetanus  the  functions  of  the  motor 
nerves  and  muscles  are  depressed,  the  motor  nerves  convey  impressions 
imperfectly,  whilst  the  muscles  contract  imperfectly  under,  direct  galvanic 
stimulation  and  become  stiff  from  rigor  mortis.  Kolliker  has  shown  that 
this  is  in  part  due  to  the  excessive  activity  these  parts  have  been  made 
to  undergo  through  the  strychnia.  But  strychnia  apparently  also  directly 
depresses  the  motor  nerves,  for  large  doses  kill  without  exciting  convul- 
sions when  the  motor  nerves  are  found  to  have  lost  their  conductivity. 
Moreover,  if,  before  poisoning,  the  sciatic  nerve  is  divided,  thus  protect- 
ing the  limb  from  convulsions,  the  divided  sciatic  loses  its  irritability, 
though  not  so  soon  as  the  undivided  nerve.  Again,  if  all  the  tissues  of  a 
frog's  leg  except  the  nerves  are  tied,  and  the  portions  beneath  the  ligature 
thus  defended  from  the  poisoned  blood,  all  parts  become  tetanized;  but 
the  convulsions  cease  sooner  in  the  poisoned  than  in  the  protected  leg, 
the  motor  nerves  of  the  former  having  been  paralyzed  by  the  strychnia- 
containing  blood. 

Ilarley's  experiments  show  that  the  poison  acts  on  all  parts  of  the 
spinal  cord,  its  effects  on  this  organ  appearing  to  be  twofold.  It  dilates 
the  vessels,  thus  increasing  the  supply  of  blood,  and  also  augments  the 
activity  of  the  functions  of  the  cord. 

It  is  stated  that  traumatic  and  strychnia  tetanus  produce  minute  ec- 
chymoses  in  the  cord.  This  is  not  the  case  with  frogs  tetanized  by  strych- 
nia;, for  these  animals  may  be  tetanized  for  weeks  without  the  produc- 
tion of  ecchymoses — a  fact  which  proves  that  ecchymoses  are  the  result 
and  not  the  cause  of  tetanic  spasms. 

It  seems  worthy  of  remark  that  strychnia  does  not  merely  heighten 
the  reflex  action  of  the  cord,  but  so  affects  it  that  impressions  are  not 
confined  within  their  natural  limits,  but  diffuse  themselves  throughout 
the  cord ;  strychnia,  in  fact,  lessens  the  resistance  of  the  cord  and  increases 
the  diffusibility  of  impression.  Strychnia  heightens  arterial  pressure  by 
stimulating  the  vaso-motor  centre. 

Nux  vomica  or  its  alkaloid  is  commonly  employed,  often  with  great 
benefit,  in  motor  paralysis.  Sometimes  it  is  administered  with  the  view 
of  exciting  slight  twitching  in  the  paralyzed  muscles,  so  as  to  keep  up 
in  them  a  sort  of  artificial  exercise  calculated  to  maintain  their  nutrition 
and  prevent  their  wasting;  but  if  strychnia  benefited  in  this  way,  surely 
galvanism  would  effect  the  object  better.  Dr.  Brown-Sequard  recom- 
mends nux  vomica  or  strychnia  in  those  forms  of  paraplegia  dependent 
on  softening  and  wasting  of  the  cord,  when,  for  example,  the  supply  of 
blood  conveyed  to  it  is  diminished  through  degeneration  and  partial 
blocking  up  of  the  vessels. 

Strychnia  is  supjiosed  to  dilate  the  vessels  and  to  increase  the  sup- 
ply of  blood  in  the  degenerated  tissues,  and  thus  to  avert  their  further 
destruction. 

Strychnia  affects  paralyzed  sooner  than  unparalyzed  muscles. 

In  medicinal  doses  strychnia  is  said  to  strengthen  the  heart  beats.  It 
has  been  shown  that  the  heart  of  an  animal  poisoned  by  strychnia  ceases 
to  contract  sooner  after  death  than  that  of  an  animal  destroyed  by  me- 
chanical means ;  and  further,  that  if  a  frog's  heart  is  placed  in  a  solution 
of  strychnia  it  ceases  to  beat  sooner  than  another  placed  in  simple  water. 
It  is  not  said  whether  this  organ  ceases  to  contract  in  the  systole  or  dia- 
stole. Harley  states  that  when  a  solution  of  strychnia  is  dropped  on  a 
heart  its  muscles  become  tetanic.     The  same  authority  says  that  both 


424  NUX    VOMICA. 

strychnia  and  brucia  lessen  the  absorption  of  oxygen  and  the  production 
of  carbonic  acid;  in  other  words,  they  lessen  the  respiratory  function  of 
the  blood,  and  if  either  alkaloid  is  mixed  with  blood  recently  drawn,  the 
amount  of  oxygen  it  absorbs  and  of  carbonic  acid  it  gives  otf,  are  less 
than  with  simple  blood.  Is  it  not  probable  that  any  substance  capable 
of  altering  the  physical  or  chemical  condition  of  the  blood  will  lessen  its 
respiratory  functions  ? 

Strychnia  stimulates  the  resjiiratory  centre,  and  clinically,  when 
given  in  full  doses,  it  is  found  of  much  service  in  chronic  bronchitis 
and  emphysema. 

Strychnia,  given  to  a  rabbit  with  young,  causes  abortion;  it  has 
therefore  been  stated  that  this  drug  possesses  a  direct  influence  on  the 
uterus,  but  there  is  no  evidence  to  confirm  this  conjecture. 

Strychnia  is  useful  in  prolapsus  ani,  and  if  this  condition  is  associated 
with  constipation;  the  nux  may  be  added  to  a  purgative,  as  tincture  of 
rhubarb.  If  diarrhoea  occurs,  it  should  be  checked,  and  the  prolapsus 
will  probably  cease;  if  not,  strychnia  will  generally  succeed  quickly  in 
ridding  a  child  of  this  troublesome  complaint.  These  preparations,  es- 
pecially the  tincture,  are  often  of  much  use  in  so-called  hysteria  of 
middle-aged  people.  In  many  cases  it  appears  to  control  the  distressing 
flatulence  commonly  connected  with  this  state,  and  to  relieve  the  sensa- 
tion of  heat  and  weight  at  the  top  of  the  head;  and  it  often  removes 
effectually,  although  less  surely,  flushings  of  the  face,  and  hot  and  cold 
perspirations.  It  is  still  more  effectual  when  combined  with  small 
quantities  of  laudanum.  Strychnia  given  hyj)odermically  or  by  the 
stomach  is  highly  recommended  in  alcoholism  and  delirium  tremens. 
Persistently  administered  it  prevents  the  recurrent  crave  for  drink,  often 
met  with  in  j)ersons  who  inherit  the  propensity  direct  from  a  drunken 
parent,  or  as  the  result  of  an  altered  neurosis.  It  must  be  administered 
in  increasing  doses.  Some  patients  have  reached  the  enormous  dose  of 
one  and  two-third  grains  of  the  extract  of  nux  daily  with  much  benefit 
and  without  the  induction  of  any  toxic  effect.  In  delirium  tremens 
strychnia  given  hypodermically  in  ^'^  to  ^  grain,  or  even  larger  doses, 
calms  excitement  and  induces  sleep. 

The  late  Dr.  Anstie  noticed  that  strychnia  sometimes  produces 
symptoms  closely  resembling  intoxication,  unsteadiness  of  gait,  perver- 
sion of  the  intellect,  and  a  meaningless  smile.  On  one  occasion  I  was 
able  to  connect  a  peculiar  wandering  delirium  at  night  with  the  employ- 
ment of  strychnia,  though  there  were  no  tetanic  twitchings. 

According  to  Dr.  Anstie,  strychnia  promotes  capillary  circulation, 
and  he  recommends  it  in  troublesome  coldness  of  the  hands  and  feet. 

Sti-ychnia  sometimes  induces  persistent  erections,  which  phenomenon 
has  led  some  medical  men  to  give  it  in  impotency  and  spermatorrhoea. 

Large  doses  of  strychnia  are  sometimes  useful  in  spermatorrhoea, 
especially  when  associated  with  impotence. 

Strychnia  is  sometimes  employed  Avith  much  benefit  to  old  people 
with  paralysis  of  the  bladder,  when  the  water  constantly  dribbles  away. 
It  may  also  be  useful  in  the  incontinence  of  urine  of  cliildren. 

Strychnia  is  sei^arated  in  part,  at  least,  by  the  kidneys.  Its  influence, 
if  any,  on  the  urine,  has  not  yet  been  ascertained. 

In  a  remarkably  able  paper,  Drs.  Crum  Brown  and  Fraser  record  some 
experiments  made  with  methyl  and  ethyl  compounds  of  strychnia,  brucia, 
and  thebaia,  and  have  arrived  at  some  astonishing  results.  While  retain- 


NUX    VOMICA.  425 

ing  most  of  tlio  chemical  properties,  giving  the  ordinary  reactions  of  strych- 
nia, brucia,  and  thebain,  yet  the  physiological  action  of  these  substances 
on  the  body  is  completely  altered.  These  obscu'vers  experimented  with 
iodide  of  methyl-strychnium,  sulphate  of  methyl-strychnium,  and  with  the 
nitrate  and  hydrochlorate  of  the  same  base,  and  likewise  with  iodide  and 
sulphate  of  methyl-brucium,  and  with  iodide  and  sulphate  of  methyl- 
thebaium. 

As  we  have  already  stated,  strychnia,  brucia,  and  thebaia  affect  the 
cord,  and  produce,  according  to  the  dose,  more  or  less  severe  tetanic  con- 
vulsion. But  these  substances,  Avhen  converted  into  the  ethyl  and  methyl 
compounds,  cease  to  act  in  this  manner,  and  produce  general  paralysis  of 
the  bod}^  an  effect  shown  by  these  experiments  to  depend  on  paralysis  of 
the  ends  of  the  motor  nerves.  In  fact,  these  new  compounds  act  on  the 
body  in  the  same  way  as  curare. 

in  their  action  on  the  heart  and  muscles  these  new  substances  were 
likewise  found  to  differ  much  from  strychnia,  brucia,  etc.;  for  after 
poisoning  by  the  methyl  or  ethyl  compounds  the  heart  continued  to 
contract  naturally  for  a  long  time,  while  the  muscles  for  many  hours  con- 
tinued flaccid,  contractile,  and  alkaline. 

Drs.  Crum  Brown  and  Fraser  further  experimented  on  codeia,  mor- 
phia, and  nicotia.     At  the  conclusion  of  their  treatise  they  say: — 

"  The  change  in  the  character  of  the  physiological  action  is  remarkably  illustrated 
by  strychnia,  brucia,  and  thebaia,  whose  purely  spinal  tetanic  action  is  converted 
into  a  paralyzing  action  on  the  periphery  (and  organs)  of  motor  nerves;  it  is  apparent 
in  codeia  and  morphia,  whose  couvulsant  action  is  also  converted  into  a  paralyzing 
action  on  motor  nerve-end  organs,  and  whose  hypnotic  action  is  apparently  altogether 
destroyed  in  the  case  of  codeia,  and  certainly  greatly  diminished  in  that  of  morphia; 
and  it  is  obvious,  though  less  so  than  with  the  others,  in  the  case  of  nicotia,  whose 
convulsant  action  is  diminished,  if  not  altogether  removed.  We  may  conclude  from 
these  facts  that  when  a  nitrite  base  possesses  a  strychnia-like  action,  the  salts  of  the 
corresponding  ammoniimi  bases  have  an  action  identical  with  that  of  curare. 

"  It  is  well  known  that  curare  and  strvchnia  are  derived  from  plants  belonging  to 
the  same  genus,  and  it  is  therefore  interesting  to  observe  such  a  relationship.  It  may 
not,  however,  be  altogether  superfluous  to  add  that  strychnia,  brucia,  and  the  other 
s]iinal  .stimulant  alkaloids  examined  in  this  paper  have  not  been  converted  by  chemical 
addition  intd  curarina — the  active  principle  of  curare.  The  action  of  the  methyl  de- 
rivatives of  these  bases  is  of  precisely  the  same  character  as  that  of  curare,  and  they 
possess  the  same  peculiarity  of  slow  absorption  by  the  mucous  membrane  of  the 
dige.stive  system,  but  the  degrees  of  their  activity  are  very  different.  If  we  confine 
our  attention  to  the  salts  of  the  methyl  derivatives  of  strychnia,  brucia,  and  thebaia, 
where  the  action  is  uncomplicated,  we  observe  they  form  a  series  in  which  the  fatal 
dose  varies  for  each,  while  this  dose,  in  the  case  of  the  most  active  oi  the  three,  is  con- 
sitlcrably  above  that  of  curare,  and  greatly  above  that  of  curarina.  Besides,  curarina 
has  a  characteristic  color  reaction  that  belongs  to  none  of  these  bodies,  and  the  latter 
further  proves  this  dissimilarity  by  each  of  them  po.s.sessing  special  color  reactions,  by 
which  they  may  be  distinguished  from  each  other.  " 

There  is  a  distinct  antagonism  between  strychnia  and  calabar  bean  and 
between  strychnia  and  chloral.  These  antagonisms  have  lately  been  in- 
vestigated by  a  committee  presided  over  by  Dr.  Hughes  Bennett.  Pre- 
vious experimenters  have  shown  that  calabar  bean  modifies  strychnia 
tetanus,  but  it  is  of  no  avail  to  save  life,  and  Dr.  Bennett's  committee 
confirm  the  conclusions,  that  whilst  the  symptoms  induced  by  strychnia, 
as  tetanic  convulsions,  are  modified  by  calabar  bean,  so  far  from  saving 
life  it  actually  helps  to  destroy  it,  for,  when  both  poisons  are  administered 
together,  but  each  in  quantity  less  than  the  minimum  fatal  dose,  their 
combined  action  in  this  dose  is  fatal. 

The  antagonism  between  chloral  and  strychnia  is  far  greater;    chloral 


426  LOBELIA    INFLATA. 

modifies  the  stryclmia  symptoms  to  a  great  extent,  and,  as  might  be  ex- 
pected, the  sooner  chloral  is  given  after  strychnia  the  greater  is  the 
antagonistic  etfect.  Very  large  doses  of  strychnia  require  very  large  and 
even  dangerous  doses  of  chloral,  enough  to  produce  serious  symptoms. 
Whilst  chloral  antidotes  strychnia,  it  is  doubtful  if  strychnia  will  avert 
death  from  chloral.  Chloral  produces  profound  coma,  and  destroys  life 
by  its  action  on  the  cerebral  hemispheres.  JStrychnia  does  not  affect 
these  parts. 


LOBELIA  IXFLATA. 

This  remedy  has  been  highly  extolled,  and  strongly  condemned, 
answering  with  some  beyond  expectation  and  to  others  yielding  nothing 
but  failure  and  disappointment.  This  discrepancy  may  be  reconciled 
easily,  for  it  will  be  found  that  lobelia  has  been  given  in  very  different 
doses  by  two  different  sets  of  authorities.  Unless  given  in  large  doses 
— doses  thought  to  be  poisonous — this  remedy  is  inoperative.  It  is  er- 
roneously imagined  that  lobelia  is  a  highly  poisonous  and  dangerous  drug, 
to  be  given  only  with  much  caution  and  close  watching.  It  contains 
lobelin.  Lobelia  first  raises  and  then  depresses  blood  pressure.  Large 
doses  paralyze  the  vaso-motor  centre  and  the  peripheral  ends  of  the  vagi. 
It  kills  by  paralyzing  the  respiratory  centre. 

Lobelia  is  of  great  service  in  many  cases  of  asthma,  whether  dependent 
or  not  on  visible  structural  changes  in  the  lung.  It  is  useful  in  the 
peptic,  and  especially  in  the  bronchitic  form.  These  two  forms  are 
generally  more  or  less  mixed,  the  tightness  of  breathing  in  bronchitic 
asthma  being  increased  by  food,  and  the  peptic  asthma  leading  after  a 
time  to  emphysema  and  bronchitis.  Lobelia,  is,  I  think,  less  useful 
when  the  attacks  come  on  periodically,  at  intervals  varying  from  about 
three  weeks  to  a  month.  It  may,  indeed,  for  several  days,  jiostpone  or 
partly  suppress  the  paroxysm,  but  after  a  time  the  lobelia  is  apparently 
unable  to  prevent  the  attack.  My  experience  leads  me  to  esteem  lobelili 
higher  the  more  I  try  it,  and  I  frequently  hear  it  extolled  by  patients. 
It  must,  however,  be  confessed  that  in  some  cases  it  fails  entirely.  In  the 
bronchitic  form  patients  often  say  it  "  helps  them  to  get  up  the  phlegm." 
It  is  hardly  necessaiy  to  observe  that  lobelia  is  not  useful  in  all  forms  of 
dyspnoea;  it  is  useless  when  this  depends  on  heart  disease,  and  when  the 
difficulty  of  breathing  comes  on  only  from  exertion,  or  from  a  bad  fit  of 
coughing.  Lobelia  being  only  palliative  and  not  curative  of  the  condi- 
tions causing  the  dyspnoea,  it  should  be  given  only  during  a  paroxvsm. 
On  any  signs  of  an  oncoming  fit  the  medicine  must  be  taken  immediately 
in  doses  of  a  drachm  of  the  simple  tincture  every  hour,  or  even  every  half 
hour,  or  ten  drops  may  be  taken  every  ten  minutes  or  quarter  of  an  hour 
till  the  dyspnoea  gives  way.  It  is  better  to  adopt  the  smaller  and  more 
frequent  dose,  as  the  medicine  can  be  discontinued,  should  sickness  or 
depression  occur.  The  great  drawback  is  its  uncertain  action,  some 
patients  being  made  sick  and  faint  by  doses  which  others  take  without 
any  such  penalty.  The  risk  of  depression  is  obviated  by  small  frequent 
doses,  and  a  patient  soon  learns  the  suitable  dose  and  periods.  It  is  well 
to  inform  patients  of  the  possible  occurrence  of  sickness  and  faintness, 
Avhich  may  make  them  feel  very  ill;  but  these  symptoms  soon  disappear, 
and  never,  so  far  as  I  have  seen,  become  serious  or  dangerous.  I  have 
repeatedly  given  two-drachm  doses  without  any  dangerous  consequences; 
but  this  large  dose  generally  excites  a  sensation  of  sinking  at  the  stomach. 


CANNABIS    INDICA.  427 

with  nausea,  and,  not  nnfreqnently,  vomiting.  When  the  patient  com- 
plains of  more  or  less  constant  tightness  of  the  chest,  with  frequent 
exacerbations  during  the  day,  he  should  take  ten  minims  of  the  tincture 
thrice  daily,  with  an  additional  dose  on  the  occurrence  o!  the  exacerba- 
tion. In  bronchitic  asthma,  where  the  breathing  is  a  little  tight  all  day, 
but  much  worse  at  night,  the  patient  should  take  ten  minims  three  times 
a  day,  with  additional  doses  according  to  the  state  of  the  breathing  at 
night.  It  should  be  given  cautiously  to  asthmatics  with  heart  disease,  or 
it  may  render  the  pulse  irregular,  and  very  weak.  Lobelia  inflata  allays 
the  dyspnoea  which  accompanies  capillary  bronchitis  in  emphysema. 

In  certain  epidemics  of  whooping-cough  lobelia  is  very  serviceable, 
whilst  in  other  epidemics  it  seems  useless.  Lobelia  is  useful  in  the  sjiasmodic 
stage,  and  in  two  or  three  days  generally  reduces  by  one  half  the  frequency 
of  the  attacks,  lessening  their  severity  at  the  same  time;  the  speedy  subsid- 
ence and  disappearance  of  the  whoop  attest  the  influence  of  this  drug.  Like 
all  other  Avhooping-cough  remedies  it  acts  best  in  uncomplicated  cases, 
and  when  the  weather  is  warm  and  mild.  If  the  weather  is  cold,  and  the 
winds  cutting  and  sharp,  the  child  should  be  confined  to  a  warm  room,- 
but  under  other  circumstances  the  child  should  live  as  much  as  possible 
in  the  open  air.  For  a  patient  two  years  old,  I  order  ten  minims  of  the 
tincture  of  lobelia  every  hour,  and  an  additional  dose  each  time  the  cough 
is  imminent,  provided  the  |  aroxysm  gives  sufficient  warning.  Children 
bear  large  doses  of  the  drug;  for,  in  no  instance  have  I  witnessed  nausea, 
sickness,  faintness,  or  any  ill  effects  follow  the  doses  Just  recommended. 
I  find,  indeed,  that  adults  are  much  less  tolerant  of  lobelia  than  chil- 
dren. Sometimes  lobelia  produces  a  slight  burning  sensation  in  the 
throat.  Whooping-cough  is  well  known  to  be  a  very  obstinate  and  dan- 
gerous affection  in  children  only  a  few  months  old,  and  in  such  cases 
lobelia  often  appears  to  do  less  good  than  to  older  children.  Even  to 
very  young  children  I  give  five  minims  of  the  tincture  every  hour.' 

Lobelia  has  been  recommended  in  broiichitis;  and  I  have  tried  it  in 
several  cases,  but  while  it  removed  any  paroxysmal  dyspnoea,  it  appeared 
to  be  powerless  over  the  bronchitis  itself.  It  has  been  employed  in  laryn- 
gismus stridulus  and  in  croup. 


CANNABIS    INDICA. 


Indiaist  hemp  does  not  affect  all  persons  similarly,  and  race  and  cli- 
mate are  supposed  to  modify  its  influence.  Its  effects  are  most  marked 
on  the  brain,  whose  functions  it  more  or  less  perverts  in  various  ways. 
It  generally  produces  a  pleasurable  intoxication,  and  the  dosed  person 
becomes  talkative,  or  sings,  or  perpetually  giggles,  and  objects  often  as- 
sumed to  him  very  grotesque  aspects,  exciting  him  to  much  merrimeiffc. 
He  is  possessed  with  a  feeling  of  happiness  and  contentment,  and  ideas 
of  a  pleasing  kind  pass  rapidly  through  the  mind,  sometimes  unconnected 
and   immediately  forgotten;  but  in  other  instances  recollected    on   the 

'  'Sir.  Foster,  of  Huntingdon,  and  Dr.  Howard  Sartjent,  of  Boston,  America,  re- 
commended clover  in  whooping-conuii.  Dr.  Sarg'ent  gives  a  wineglassf ul  occasionally 
through  the  day,  of  an  infusion  made  with  two  ounces  of  carefully  dried  blossoms  of 
red  clover,  steeped  in  a  pint  of  boiling  water  for  four  hours. 


428  CANNABIS    INDICA. 

return  to  the  normal  state.  The  delirium  is  sometimes  furious.  After 
a  time  sleep  sets  in,  generally  accompanied  Avith  delightful  dreams.  There 
may  be  pain  in  the  head,  "  a  sensation  as  of  the  Ijrain  boiling  over  and  lift- 
ing the  cranial  arch,  like  the  lid  of  a  tea  kettle."  Among  the  early  symp- 
toms is  a  sensation  of  heaviness  of  the  arms  and  legs.  The  head  feels  hot 
and  heavy.  The  eyes  are  bright  and  shiny,  with  sometimes  giddiness  and 
noises  in  the  ears.  General  sensibility  is  also  alfected,  and  pricking  in 
the  feet,  or  over  the  whole  bod}^  Avith  num.bness,  often  of  a  pleasurable 
kind,  is  an  early  symptom.  Pressure  on  the  skin  may  excite  a  sensation 
of  burning.  After  a  time,  complete  anaesthesia  sets  in  to  sucli  an  extent 
that  while  standing  there  may  be  no  consciousness  of  touching  the  ground. 
The  muscular  sense  is  even  lost,  and  pain  is  lessened  or  removed.  Some- 
times it  produces  complete  catalepsy.  It  often  occasions  a  ravenous  sen- 
sation, not  to  be  appeased  by  food.  In  some  instances  the  pulse  is  said  to 
be  at  first  rather  increased  in  frequency  and  strength,  Init  neither  pulse 
nor  breathing  is  much  altered.  It  dilates  the  pupils,  but  they  contract 
to  light.     Sometimes'  there  is  strong  sexual  desire. 

Such  is  the  group  of  symptoms  induced  by  Indian  hemp,  though  they 
do  not  all  occur  in  the  same  person,  but  are  variously  combined ;  and  some- 
times it  produces  sensations  anything  but  pleasant,  as  nausea,  vomiting, 
great  thirst,  frequent,  weak,  and  intermittent  pulse,  Avith  disagreeable 
sensations  and  ideas. 

If  indulged  in  for  a  long  time,  as  is  common  in  the  East,  it  produces 
loss  of  appetite  and  strength,  trembling,  and  much  mental  Aveakness. 

It  is  used  to  produce  sleep,  and  its  effects  have  been  coriipared  to  those 
of  opium;  but  it  differs  from  this  drug,  it  is  said,  in  not  producing  nausea, 
constipation  or  headache.  Fronmiiller  administered  it  in  1,000  cases,  and 
found  that  it  succeeded  in  530;  partly  succeeded  in  215;  and  produced 
little  or  no  effect  in  255  instances.  A  large  dose  is  required  to  induce  a 
hypnotic  effect,  as  eight  grains  of  the  spirituous  extract,  Avliich  sometimes, 
soon  after  its  administration,  excites  headache,  A'omiting,  and  giddiness; 
and  the  headache  may  be  severe,  dull,  and  throbbing,  and  accompanied 
by  a  coated  tongue.  The  preparation  used  by  Fronmiiller  must  be  far 
Aveaker  than  the  extract  employed  in  this  country,  for  in  some  cases  even 
half  a  grain  of  native  extract  excites  disagreeable  symptoms. 

Cannabis  indica  is  one  of  the  most  valuable  remedies  for  megrim  or 
sick  headache.  It  appears  to  act  on  the  nervous  centre  Avhence  this  head- 
ache springs.  It  is  found  serviceable  both  in  cases  associated  Avitli  little 
or  no  nausea,  and  in  cases  accompanied  by  severe  vomiting.  It  is  useful 
in  attacks  accompanied  Avith  spectra.  It  is  most  useful,  in  my  experience, 
in  preventing  the  attacks,  not  in  arresting  them  Avhen  once  they  luiA^e 
begun.  It  is  sometimes  useful  in  those  seA^ere,  continuous  forms  of  head- 
ache lasting  for  Aveeks  (see  Croton  Chloral) ;  but  it  is  especially  effective 
when  from  fatigue,  anxiety,  or  change  of  life  the  attacks  become  much 
more  frequent;  then  the  drug  gradually,  and  indeed  sometimes  quickly, 
lengthens  the  interA'al,  and  at  last  brings  back  the  attacks  to  their  old 
periodicity,  or  eA'en  extends  the  interA-als  between  the  seizures.  It  need 
hardly  be  said  that  cannabis  Avill  not  cure  these  patients.  I  have  given 
this  drug  Aveeks  or  months  continuously,  in  doses  of  one- third  to  one- 
half  a  grain  twice  or  thrice  daily.  As  ana?mia  or  constipation,  favoring  and 
even  exciting  attacks  of  migraine,  often  co-exist  Avith  it,  cannabis  indica 
may  be  combined  in  pills  Avith  eitlier  iron  or  aloes. 

Subsequent  exi^erience  has  fully  confirmed  the  favorable  ojiinion  of  it 


ERGOT.  429 

just  expressed;  no  single  drug  have  I  found  so  useful  in  migraine. 
Not  only  is  cannabis  indica  useful  in  the  inter-paroxysmal  period  to 
prevent  headaches,  but  a  third  to  half  a  grain  of  the  extract  given  at  the 
commencement  of  an  attack  will  sometimes  cut  short  the  paroxysm.  In 
the  inter-paroxysmal  period  I  generally  give  half  a  grain  of  the  extract 
three  times  a  day;  but  sometimes,  especially  in  women,  this  dose  induces 
very  disagreeable  symptoms,  which  may  not  occur  till  after  several  days^ 
use  of  the  drug. 

Dr.  Clousden  recommends  cannabis  indica  combined  with  bromide  of 
potassium  in  mania,  giving  a  drachm  of  bromide  of  potassium  with  a 
drachm  of  the  tincture  of  cannabis  indica. 

It  has  been  found  useful  in  neuralgia,  whooping-cough  and  asthma, 
and  it  appears  to  be  serviceable  in  some  cases  of  hysteria.  Some  accord 
it  a  high  reputation  as  a  diuretic  in  acute  and  chronic  Bright's  disease, 
and  consider  bloody  urine  to  be  a  special  indication.  It  is  said  to 
relieve  dysuria  and  strangury,  and  to  be  useful  in  retention  of  urine, 
dependent  on  paralysis  from  spinal  disease.  It  is  used  occasionally  in 
gonorrhoea.  It  is  very  useful  in  menorrhagia,  or  dysmenorrhoea.  Half 
a  grain  to  a  grain  thrice  daily — though  a  grain  every  two  hours,  or  hourly, 
is  sometimes  required  in  those  who  can  tolerate  so  large  a  dose — often 
relieve  the  pain  of  dysmenorrhoea.  It  'is  said  to  increase  the  energy  of 
internal  contractions.  It  is  also  recommended  in  impotency.  Possibly 
owing  to  differences  in  the  quality  of  the  drug,  but  generally  on 
account  of  some  peculiarity  on  the  part  of  the  patient,  we  find  that 
even  half  a  grain  of  the  extract  strongly  affects  some  persons.  No 
doubt  women  are  more  powerfully  affected  by  the  drug  than  men.  I 
have  known  cases  wdien  half  a  grain,  three  times  a  day,  was  well  borne, 
and  with  benefit  for  many  days,  and  then  suddenly  disagreeable  and 
pronounced  symptoms  rose,  which  could  not  be  accounted  for  by  the 
time  or  circumstances  under  which  the  medicine  was  taken.  It  is 
better  to  begin  with  a  quarter  of  a  grain  of  the  extract  at  first,  to  test 
the  patient's  tolerance,  and  if  this  is  well  borne  then  the  dose  should 
be  increased. 


ERGOT. 

Large  doses,  even  an  ounce  of  the  liquid  extract,  are  sometimes  ad- 
ministered immediately  after  delivery,  and  without  producing  toxic 
effects.  Further,  ergot  is  sometimes  administered  in  considerable  doses 
for  a  long  period  without  in  any  way  deranging  the  health,  hence  whilst 
producing  powerful  therapeutic  effects  it  has  but  little  toxic  action. 

Ergot  has  a  disagreeable,  bitter  taste,  and  occasions  an  abundant  se- 
cretion of  saliva.  In  large  doses  it  produces  nausea,  vomiting,  colic, 
diarrhoea,  giddiness,  dilatation  of  the  papil,  great  retardation,  and  slight 
weakness  of  the  pulse,  pain  in  the  head,  dimness  of  vision,  giddiness 
and  stupor. 

Whether  administered  by  the  stomach  or  hypodermically,  ergot 
contracts  the  arteries  and  greatly  heightens  arterial  pressure.  Injected 
into  the  jugular  vein  it  produces  at  first  for  a  short  time  a  slight  fall 


430  ERGOT. 

of  blood  pressure,  followed  by  a  great  rise  in  tension.  "Wood  and  others 
find  that  division  of  the  spinal  cord  prevents  the  heightened  tension, 
showing  that  ergot  stimulates  the  vaso-motor  centre.  Dr.  8ainsbury's 
and  my  own  ex])eriments  show  that  a  weak  solution  of  ergotin  in  saline 
solution  circulating  through  the  posterior  part  of  the  body  of  a  tortoise, 
Avhose  spinal  cord  is  completely  destroyed,  greatly  retard's  the  flow  of 
the  fluid  through  the  vessels;  showing  that  ergot,  by  its  influence  on 
either  the  jjerijjheral  nervous  system  or  on  the  muscular  tissue  of  the 
blood-vessels,  certainly  induces  strong  contraction. 

Ergot  slows  and  weakens  the  heart,  hence  the  rise  of  blood  pressure  in 
no  way  depends  on  the  influence  of  ergot  on  the  heart.  The  slowing  of 
the  heart  is  due  to  stimulation  of  the  terminations  of  the  vagi,  for  the 
slowing  does  not  occur  if  atropia  is  administered  before  ergot.  Large 
doses  arrest  the  heart  in  diastole,  and  strong  direct  excitation  does  not 
induce  contraction,  showing  that  the  arrest  is  not  due  to  inhibition 
through  the  vagus,  but  depends  on  the  direct  action  of  the  ergot  on  the 
cardiac  muscle. 

Ergot  stimulates  involuntary  muscular  fibre  and  so  increases  ver- 
micular action  of  the  intestines,  induces  contraction  of  the  bladder  and 
of  the  uterus,  especially  in  its  pregnant,  and  still  more  in  its  parturient 
condition. 

Large  doses  induce  ansesthesia  and  paralysis,  probably  through  the 
spinal  cord.  The  motor  nerves  and  muscles  are  unaffected.  It  kills  by 
paralyzing  the  respiratory  centre  and  arresting  respiration. 

Administered  either  by  the  stomach  or  hypodermically,  it  is  most 
valuable  in  haemorrhage;  indeed  in  this  respect  few  if  any  remedies 
rival  its  efficacy.  Dr.  Currie  Eitchie  and  Dr.  Drasche  were  the  first  to 
use  it  hypodermically,  and  they  report  successfully  of  cases  of  haemop- 
tysis, epistaxis,  haematemesis,  and  intestinal  hsmorrage  in  typhoid 
fever;  and  many  other  observers  have  since  confirmed  their  statements. 
In  severe  bleeding,  when  it  is  urgently  necessary  to  check  it  at  once, 
the  hypodermic  application  must  be  used,  in  from  two-  to  five-grain  doses 
of  ergotin.  I  have  seen  this  injection  in  many  instances  produce  a 
good  deal  of  swelling  and  pain,  which,  however,  always  subsided  without 
suppuration.  It  is  well  to  warn  the  patient  that  this  temporary  unto- 
ward accident  may  occur,  ^o  irritation  arises  if  the  injection  is  made 
into>  muscular  tissue  instead  of  connective  tissue.  In  less  urgent  bleed- 
ing, administration  by  the  stomach  is  very  successful.  It  is  very  useful 
in  haemoptysis,  in  doses  of  thirty  or  forty  or  even  sixty  minims  of  the 
liquid  extract  every  three  or  four  hours,  indeed  hourly  in  severe  cases. 

Hildebrand  advises  hypodermic  injections  of  ergot  for  fibrous  tumor 
of  the  womb;  a  curious  measure,  it  would  seem,  but  it  is  indorsed  by 
Drs.  Keating  aiid  Ashurst,  distinguished  American  physicians,  Avho  state 
that  the  injections  at  intervals  of  five  to  six  grains  of  ergotine  Avill  greatly 
diminish  the  size  of  fibrous  tumors.  In  a  case  reported  by  Dr.  Keating 
the  pulse,  respirations,  and  temperature  fell  for  a  time  after  each  injec- 
tion, the  fall  increasing  with  each  injection;  thus,  after  the  fifteenth 
injection,  the  pulse  fell  to  fifty-six,  the  respirations  to  twelve,  and  the 
temperature  to  ninety-six  (?)  The  ergotin  excited  much  nausea  and 
sickness;  due  probably  to  the  effect  of  the  ergot  on  the  Avomb,  for  the 
introduction  of  the  finger  into  the  os  uteri  increased  the  vomiting.  The 
occurrence  of  luiusea  and  sickness,  however,  is  not  usual. 

Ergot  is  strongly  recommended  in  purpura. 


ERGOT.  431 

If  taken  for  a  long  time  it  is  said  sometimes  to  produce  fatal  conse- 
quences, namely,  spasmodic  contractions  of  the  muscles,  and  now  and 
then  gangrene  of  the  extremities,  in  character  generally  like  senile  gan- 
grene. These  statements,  usually  repeated  in  therapeutic  works,  must  be 
very  greatly  exaggerated,  as  we  now  administer  considerable  quantities  of 
ergot  for  weeks,  or  even  months,  without  joroducing  either  gangrene  or 
spasm. 

Its  effects  are  most  expressed  on  the  womb,  especially  when  pregnant, 
exciting  in  the  gravid  uterus  powerful  and  continuous  contractions.  It 
is  used  in  tedious  labors,  when  the  uterus  is  becoming  exhausted,  but 
must  not  be  employed  when  there  is  obstruction  to  the  passage  of  the 
child,  otherwise  it  may  occasion  serious  damage  to  the  delicate  structures 
of  the  mother.  Many  suppose  that  it  endangers  the  life  of  the  child  in 
two  ways,  namely,  by  subjecting  it  to  jjowerful  and  continuous  uterine 
pressure,  and  by  weakening  its  heart.  This  injurious  pressure  may  be 
avoided,  it  is  said,  by  administering  the  medicine  in  small  doses,  so  as  to 
strengthen  the  natural  intermittent  contractions  of  the  uterus,  but  not  to 
make  them  continuous.  It  is  recommended  to  watch  its  action  on  the 
foetal  heart,  and  if  the  pulsations  fall  to  110,  or  the  beats  become  irregu- 
lar, either  the  drug  should  be  discontinued  or  the  delivery  effected  by 
instruments. 

It  is  'extremely  useful  in  post-partum  hemorrhages,  arresting  the 
bleeding  by  producing  firm  contraction  of  the  uterus,  and  by  its  influence 
on  the  blood-vessels.  It  is  also  of  great  use  in  the  various  forms  of  men- 
orrhagia,  even  when  it  depends  on  uterine  tumors.  It  is,  perhaps,  the 
most  valuable  medicine  known  in  uterine  haemorrhage,  cliecking  the 
bleeding  when  other  remedies  have  failed,  and  when  the  patient  is  reduced 
almost  to  a  helpless  state.  In  such  critical  circumstances  it  must  be 
given  in  full  doses.  Some  doctors  give  half  an  ounce  of  the  liquid  ex- 
tract, and  repeat  it  in  half  an  hour,  or  even  in  a  shorter  time,  without  any 
toxic  effects.  It  promptly  checks,  and  in  a  few  hours  effectually  stays 
the  bleeding.  Dry  cupping  over  the  sacrum  is  useful.  Perfect  rest 
should  be  enjoined. 

It  is  said  that  ergot  will  arrest  sweating. 

Ergot  is  said  to  reduce  the  temperature  of  the  body,  but  most  ob- 
servers doubt  the  truth  of  this  assertion.  The  hypodermic  injection  is 
said  to  reduce  the  temperature  of  cats  and  dogs. 

It  is  stated  to  be  useful  in  neuralgia  and  paraplegia,  whooping-cough, 
incontinence  of  urine,  and  even  in  some  cases  of  leucorrhoea;  but  the 
form  of  leucorrhoea  is  not  mentioned.  It  is  also  recommended  in  amen- 
orrhoea  with  ansemia,  after  the  use  of  iron.  Perroten  strongly  praises 
ergotine  injections  in  prolapsus  of  the  rectum. 

It  is  the  most  useful  remedy  in  diabetes  insipidus,  and  Da  Costa  first 
employed  it  in  this  disease.  The  dose  should  be  regulated  by  the  effect, 
but  doses  large  and  frequent  are  often  required. 

Dr.  Davidson  reports  a  singular  case  of  poisoning  by  ergot.  A  preg- 
nant woman  for  several  months  took  large  doses  of  liquid  extract  and 
powdered  ergot,  till  at  last  it  caused  death.  When  called  to  see  the 
patient  she  complained  of  lumbar  and  arthritic  pains,  and  vomited  a  red- 
dish brown  pultaceous  matter  (blood).  She  passed  urine  looking  like 
blood.  After  his  visit  she  vomited  half  a  pint  of  blood.  The  upper  part 
of  the  body  was  intensely  jaundiced.  She  had  "  genuine  black  eye." 
Her  lips  and  tongue  were  swollen  and  covered  with  dry  black  blood. 


432  COFFEE. 

Her  heart  beat  150  per  minute.  After  death  he  found  numerous  ecchy- 
moses  in  the  subcutaneous  fat  in  the  peritoneum  and  in  the  lungs.  Also 
much  blood  in  the  peritoneal  cavity  and  in  the  stomach  and  intestines. 


COFFEE.    CAFFEINE. 

Caffeii^e  is  now  largely  used  on  account  of  its  action  on  the  heart; 
and  also  mainly  for  its  influence  on  the  kidney,  since  it  acts  as  a  direct 
diuretic.  It  is  generally  given  in  the  form  of  citrate,  in  the  dose  of  two 
to  five  grains  several  times  a  day. 

Dr.  Pratt  took  twelve  grains  of  caffeine,  which  induced  restlessness, 
mental  depression,  muscular  tremulousness,  frequent  desire  to  pass  water, 
and  great  sleeplessness. 

A  man  took  a  drachm  of  the  citrate  by  mistake.  There  occurred 
burning  in  the  throat,  giddiness,  nausea,  faintness,  numbness,  tremors, 
free  diuresis,  great  cardiac  weakness,  cold  extremities,  collapse.  Intelli- 
gence was  not  affected.     The  man  recovered.     (Routh.) 

Poisonous  doses  given  to  mammals  produce  restlessness,  hurried 
breathing,  muscular  weakness,  tetanic  and  clonic  convulsions,  and  death 
from  respiratory  paralysis. 

It  affects  then  both  the  brain  and  cord,  the  mental  alterations  being 
due  to  its  influence  on  the  brain,  and  the  tetanus  to  its  action  on  the  cord. 

In  frogs  it  induces  rigidity  by  its  direct  action  on  the  muscles.  At 
first  it  accelerates  the  heart's  action,  but  soon  the  contractions  grow  in- 
frequent and  irregular,  these  effects  being  due  to  the  direct  action  of 
caffeine  on  the  heart.     It  heightens  arterial  pressure. 

Binz  and  Leven  find  that  heightened  arterial  tension  occurs  after 
section  of  the  vagus. 

The  motor  nerves  are  unaffected.  Pratt  finds  that  the  sensory  nerves 
are  depressed. 

It  strengthens  the  cardiac  contractions  and  heightens  arterial  tension, 
thus  acting  like  digitalis,  which  in  some  measure  it  can  therapeutically 
take  the  place  of.  Some  say  it  is  more  efficacious  than  digitalis,  but 
certainly  this  has  not  been  my  experience,  and  certainly  it  possesses  less 
power  to  regulate  an  irregularly-acting  heart. 

Subsequent  experience  has  fully  demonstrated  the  inferiority  of 
caffeine  to  digitalis.  It  is,  however,  a  useful  adjunct  to  digitalis  in  cases 
of  cardiac  disease. 

Coffee,  to  some  persons,  is  slightly  purgative. 

The  active  principle  of  tea  and  coffee  is  absorbed,  and  acts  as  a  stim- 
ulant to  the  nervous  system.  These  beverages  are  especially  useful  in  a 
fatigued  state  of  the  system,  and  under  ordinary  circumstances  are  pref- 
erable in  this  respect  to  alcoholic  drinks. 

"  Coffee,"  says  Dr.  Parkes,  in  his  work  on  Hygiene,  "  is  a  most  imj^or- 
tant  article  of  diet  for  soldiers,  as  not  only  is  it  invigorating,  without 
producing  subsequent  collapse,  but  the  hot  infusion  is  almost  equally 
serviceable  against  both  cold  and  heat,  in  the  one  case  the  warmth  of  the 
infusion,  in  the  other  the  action  of  the  skin,  being  useful,  while  in  both 


COFFEE.  433 

cases  tlie  nervous  stimulation  is  very  desirable.  Dr.  Hooker  tells  us  that 
in  the  Antarctic  Expedition  the  men  all  j^referred  coffee  to  spirits,  and 
this  was  the  case  in  the  Schleswig-Holstein  war,  1849.  The  experience  of 
Algeria  and  India,  where  coffee  is  coming  more  and  more  into  use,  proves 
its  use  in  hot  climates."  The  same  authority,  speaking  of  tea,  says, 
"  Tea  seems  to  have  a  very  decidedly  stimulative  and  restorative  action  on 
the  nervous  system,  which  is  perhaps  aided  by  the  warmth  of  the  infusion. 
No  depression  follows  this.  The  pulse  is  a  little  quickened ;  the  amount 
of  pulmonary  carbonic  acid  is,  according  to  E.  Smith,  increased.  The 
action  of  the  skin  is  increased,  that  of  the  bowels  lessened.  The  kidney 
excretion  is  little  affected;  perha2)s  the  urea  is  a  little  lessened,  but  this 
is  uncertain." 

"As  an  article  of  diet  for  soldiers  tea  is  most  useful.  The  hot  infusion, 
like  that  of  coffee,  is  potent  against  both  heat  and  cold,  is  most  useful  in 
groat  fatigue,  especially  in  hot  climates  (Ranald  Martin),  and  also  has  a 
great  purifying  effect  on  water." 

Tea  and  coffee  are  useful  in  the  headache  of  nervousness  and  exhaus- 
tion, and  as  an  aid  in  rousing  and  keeping  a  patient  awake  in  opium 
poisoning. 

A  small  cup  of  very  strong  coffee  is  often  very  useful  in  the  paroxysm 
of  asthma;  in  fact  it  gives  relief  in  most  cases,  but  in  very  unequal  de- 
gree. Caffeine,  as  first  recommended  by  Gubler  and  Leech,  is  largely 
employed,  in  five-grain  doses,  as  a  diuretic  in  ascites  and  cardiac  and 
renal  dropsy. 

In  cardiac  drojjsy  it  is  much  inferior  to  digitalis  and  its  allies.  In 
renal  dropsy  it  is  very  uncertain,  in  some  cases  acting  abundantly,  but 
in  most  cases  producing  little  or  no  increase  of  urine.  This  difference 
in  its  action  is  dil^ticult  to  explain.  A  similar  difference  occurs  in  healthy 
persons;  in  some  coffee  stimulating  the  kidneys  strongly;  in  other  persons 
producing  no  effect;  and  this  individual  difference  may  modify  the  action 
of  caffeine  in  disease.  It  is  supposed  to  act  on  the  kidneys  in  two  ways 
— to  increase  the  amount  of  blood  flowing  through  the  kidneys,  and  to 
stimulate  the  secretiiig  structures  of  the  kidneys. 

The  influence  of  caffeine  on  the  general  circulation,  and  on  the  circu- 
lation through  the  kidney,  has  been  ably  investigated  by  Dr.  Bradford 
and  Dr.  Phillips.  The  following  is  an  account  Dr.  Bradford  has  kindly 
prepared  for  me : 

"  The  method  of  experimentation  was  as  follows:  In  chloroformed 
and  curarized  animals  (mainly  dogs)  the  general  blood  pressure,  the 
volume  of  the  kidney,  and  the  rate  of  the  flow  of  urine  were  simultane- 
ously recorded  on  a  moving  surface.  A  solution  of  the  particular  drug 
experimented  with  was  then  injected  into  the  external  jugular  vein,  and 
the  moment  of  injection  was  also  recorded.  The  general  blood  pressure 
was  recorded  by  connecting  the  carotid  artery  with  a  mercurial  mano- 
meter, the  volume  of  the  kidney  by  means  of  Eoy's  oncometer,  and  the 
flow  of  urine  by  an  apparatus  so  constructed  that  each  drop  of  urine,  as 
it  fell  from  a  cannula  placed  in  the  ureter,  made  a  mark  on  the  blackened 
surface  of  the  drum. 

"By  means  of  this  method  it  was  possible  not  only  to  determine  the 
action  of  a  drug  on  the  circulation  and  secretion  of  the  kidney,  but  also 
to  see  whether  those  results  are  due  to  a  direct  action  on  the  kidney,  or 
only  to  an  indirect  action  resulting  from  the  effects  of  the  drug  on  the 
heart  and  vascular  system  generally. 
28 


434  COFFEE. 

""When  a  solution  of  citi'ate  of  cafFcinc  is  injected  into  tlie  external 
jugular  vein  in  doses  of  half  a  grain  to  a  grain  of  the  salt,  the  following 
changes  are  seen  to  occur:  The  general  blood  pressure  is  lowered  at 
first,  and  this  fall  is  followed  by  a  slighter  rise;  but  witli  such  doses  as 
the  above  both  effects  are  small  and  transitory.  The  fall  of  j^ressure  is 
due  to  a  diminution  in  the  force  of  the  cardiac  beats,  and  this  is  followed 
by  a  period  during  which  the  heart  beats  are  slowed  and  markedly 
strengthened,  to  be  in  turn  followed  by  a  period  of  acceleration,  of  short 
duration,  however,  during  which  the  blood  jjressure  regains,  or  even 
slightly  exceeds,  its  former  level. 

"  The  effects  on  the  kidney  are,  however,  much  more  marked.  Im- 
mediately after  the  injection  the  kidney  contracts,  and  this  contraction 
may  last  for  as  long  as  one  or  two  minutes — that  is  to  say,  for  a  much 
longer  time  than  the  effects  produced  on  the  general  blood  pressure, 
whicli  only  persist  for  some  twenty  or  thirty  seconds.  This  contraction 
or  diminution  in  bulk  of  the  kidney  is  very  considerable,  and  is,  no 
doubt,  due  to  constriction  of  the  renal  vessels.  It  is  followed  by  a  large 
expansion — that  is  to  say,  the  kidney  not  only  returns  to  its  previous 
volume,  but  it  expands  considerably  beyond  it.  This  expansion  of  the 
kidney  is  of  much  longer  duration  than  the  j)revious  contraction,  and  its 
course  is  also  slower — that  is  to  say,  the  dilatation  of  the  renal  vessels  is 
gradual,  whereas  their  previous  constriction  w^as  quite  sudden.  The 
renal  dilatation  may  persist  for  as  long  as  twenty  or  even  thirty  minutes. 

"  Thus  the  action  of  caffeine  on  the  kidney  vessels  is  a  double  one,  and 
the  observed  effects  on  the  volume  of  the  kidney  are  directly  due  to  this, 
and  not  indirectly  to  any  effect  on  the  general  blood  pressure.  That 
this  is  the  case  is  shown  by  the  fact  that  smaller  doses,  i.e.,  ^  to  ^  graii^j 
will  produce  marked  effects  on  the  kidney  without  any  very  obvious 
variations  occurring  in  the  general  blood  pressure. 

"The  action  of  the  drug  on  the  heart  is  probably  also  a  mixed  one; 
not  only  does  it  cause  a  diminution  in  the  force  of  the  beats,  but  it 
jjrobably  at  the  same  time  causes  a  contraction,  tonic  in  character,  of  the 
ventricular  muscle.  As  a  result  of  this,  the  capacity  of  the  heart  is  di- 
minished, and  hence  a  smaller  quantity  of  blood  will  leave  the  organ  at 
each  systole,  thus  leading  to  the  fall  of  arterial  pressure. 

"The  effects  on  the  flow  of  urine  are  also  very  marked.  During  the 
period  of  the  contraction  of  the  kidney  the  flow  is  either  greatly  dimin- 
ished or  even  arrested.  During  the  subsequent  expansion  the  rate  of 
flow  is  greatly  increased,  and  this  increased  rate  persists  for  as  long  as 
the  renal  dilatation.  Many  other  drugs  besides  caffeine  will  produce  con- 
traction of  the  kidneys,  but,  apparently,  this  is  the  only  drug  that  pro- 
duces any  actual  arrest  of  the  urinary  secretion  during  this  contraction. 
Ulexin,  a  powerful  alkaloid  obtained  from  the  seeds  of  gorse,  has  a  very 
similar  action  on  the  kidney  to  that  of  caffein,  producing  at  first  con- 
traction, then  dilatation  accompanied  by  free  diuresis.  Its  diuretic  action, 
however,  is  more  transitory  than  that  of  caffeine,  and,  inasmuch  as  it 
l^roduces  violent  vomiting  in  the  human  subject,  it  is  not  a  drug  at  all 
suitable  for  diuretic  purposes.  Tiiere  is,  however,  one  point  of  interest 
with  regard  to  these  two  drugs.  If  several  doses  of  caffeine  be  injected 
into  the  circulation  at  short  intervals  we  soon  arrive  at  a  jioint  when 
each  injection  causes  only  contraction  of  the  kidney,  and  diminished 
secretion;  no  diuretic  effect  whatever  being  produced  by  the  drug.  With 
ulexin  it  is  different;  repeated  doses,  or  single  large  doses,  onl}^  jaroduce 


COCAINE.  435 

a  moderate  degree  of  expansion  instead  of  the  double  effect  of  contraction 
followed  by  expansion.  With  regard  to  caffeine,  this  difference  in  the 
action  when  the  doses  are  repeated  too  rapidly  may  be  a  point  of  some 
practical  importance,  since,  under  these  circumstances,  the  drug  ceases 
to  be  a  diuretic. 

"  Many  other  substances  will  produce  expansion  of  the  kidney,  as,  for 
instance,  urea,  acetate  and  chloride  of  sodium,  etc.,  but  in  no  case  are  the 
results  so  marked  as  with  caffeine." 

Although  tea  and  coffee  are  very  wholesome  beverages,  yet  either  one 
or  the  other,  or  both,  will  in  some  persons  occasion  23alpitation  of  the 
heart,  sleeplessness,  and  mental  excitement. 

Some  maintain  that  caffeine  is  as  useful  as  a  local  anaesthetic  as 
cocaine;  thus  two  minims  of  2.5  per  cent,  solution  completely  removed 
sensibility  (Terrier) ;  and  Dr.  Faurel  emi^loys  a  2  per  cent,  solution  of 
caffeine  almost  to  tlie  exclusion  of  cocaine  in  affections  of  the  pharynx 
and  larynx.  This,  however,  does  not  agree  with  the  experience  of  others. 
Dr.  Laborde  could  not  obtain  anaesthesia  of  the  cornea  with  even  con- 
centrated solutions,  nor  with  theine;  but  Laborde  finds  that  a  glucoside 
obtained  from  Boldo  produced  anaesthesia  quite  equal  to  cocaine. 

Caffeine,  often  in  the  form  of  effervescing  citrate  of  caffeine,  is  useful 
in  sick  headache  (migraine).  Salicylate  of  soda,  or  antijDyrine,  or  anti- 
febrine,  are,  however,  much  more  effectual. 

The  following  solution  is  usefiil  for  hypodermic  use : — Twenty  grains 
of  caffeine,  seventeen  and  a  half  grains  of  salicylate  of  soda,  and  a  fluid 
drachm  of  water.  Three  minims  of  this  solution  contain  one  grain  of 
caffeine. 


COCAINE. 

[%  Dr.  Dudley  W.  Buxton.'] ' 

Cocaine  produces  a  localized  anaesthesia  when  applied  to  the  mucous 
membrane  or  skin;  its  action  is  extended  more  deeply  when  a  hypodermic 
injection  is  made  into  the  subcutaneous  tissues.  Paul  Bert  asserts  that 
the  action  of  cocaine  is  purely  local,  only  extending  so  far  as  the  drug 
actually  comes  in  contact  with  the  tissues.  However,  this  does  not  corre- 
spond with  the  experience  of  others.  It  has  been  thought,  although  as 
yet  no  sufficient  proof  has  been  advanced,  that  cocaine  acts  by  paralyzing 
the  terminal  twigs  of  the  sensory  nerves,  as  well  as  sensory  end  organs. 
On  the  other  hand,  many  careful  observers  have  come  to  the  conclusion 
that  the  anaesthesia  caused  by  cocaine  is  due  to  vaso-motor  action.  The 
cocainized  area  becomes  pale,  blanched,  and  finally  almost  bloodless,  so 
that  the  sensory  nerves,  being  deprived  of  their  due  blood  supply,  cease 
to  communicate  painful  impressions  received  from  without.  It  is  found 
that  there  is  firstly  a  loss  of  sensibility  to  pain,  next  to  variations  in  tem- 
perature, and  finally  tactile  sense  is  abolished. 

'  The  additions  to  this  article,  between  brackets,  for  the  present  edition  are 
made  by  me,  S.  R. 


436  COCAINE. 

And  further,  the  nerves  of  special  sense  cease  to  convey  their  peculiar 
impressions.     The  cocainized  mucous  membrane  of  the  nose  loses  its  ap-      7 
preciation  of  smell,  so  that  of  the  tongue  is  devoid  of  power  of  taste.     In       : 
every  case  the  effect  produced  is  transitory,  and  j^asses  off  in  from  twenty 
minutes  to  half  an  hour.  _  _       ^ 

"When  jiainted  over  the  skin,  a  sensation  of  warmth  is  at  first  experi-  ■ 
enced,  to  be  succeeded  in  a  few  minutes  by  complete  loss  of  sensation,  * 
the  part  becoming  anaemic. 

The  depth  to  which  the  action  of  cocaine  penetrates  seems  to  differ 
considerably,  but  in  no  case  does  the  anaesthesia  appear  to  extend  beyond 
the  structures  j^roper  to  the  skin  and  mucous  membrane. 

Coca  has  long  been  known  to  exert  very  decided  influence  over  the 
central  nervous  system.     Many  South  American  tribes  habituate  them- 
selves to  feats  of  endurance  by  its  use,  needing,  it  is  said,  little  food  or 
rest  while   under    its  influence.     Aschenbrandt  administered  4-  gr.  of 
hydrochlorate  of  cocaine  to  Bavarian  soldiers  without  their  knowledge 
and  found  it  removed  their  sense  of  fatigue,  while  it  enabled  them  to 
undergo  fresh  hardships  and  to  subsist  on  a  minimal  diet.    He  found  no      • 
subsequent  ill  effects  followed  this  treatment.     However,  Moreno  and       I 
Maiz  state  that  coca  habitues  suffer  from  impaired  digestion,  emacia-      * 
tion,  muscular  tremor  and  die  of  marasmus. 

IJpon  the  centre  nervous  system  cocaine  acts  as  an  excitant.  Tumas, 
of  St.  Petersburg,  found  that  painting  over  the  exposed  motor  areas  of  the 
brain  lessened  their  excitability,  but  without  any  initial  increase,  and  he 
also  showed  that  epileptiform  convulsions  were  provoked  with  difficulty, 
and  required  a  very  strong  Faradic  current  when  the  motor  area  had  been 
previously  painted  with  cocaine.  In  the  lower  animals,  the  first  effect 
of  cocaine  is  to  produce  a  curious  calm,  to  which  succeeds  a  period  of  great 
excitement.  Weakness,  marked  by  muscular  tremors,  then  appears,  and 
the  tremors  later  on  pass  into  convulsive  movements,  while  the  wealvuess 
gives  place  to  paralysis.  The  head  rolls  from  side  to  side  like  a  pendulum, 
a  phenomenon  which  Von  Anrep  attributes  to  some  alteration  caused  by 
cocaine  in  the  tension  of  the  fluids  of  the  semicircular  canals.  Epilepti- 
form convulsions  are  developed  subsequently,  and  finally  tetanic  (spinal) 
rigidity  supervenes,  and  the  animal  dies  asphyxiated. 

The  reflexes  were  increased,  and  this  took  place  both  before  and  after 
section  of  the  spinal  cord.  In  dogs  large  doses  cause  great  excitement, 
with,  expression  of  joyousness  and  delight,  but  if  the  dose  be  pushed,  the 
animals  became  dejected  and  struck  with  terror,  their  limbs  trembled, 
and  they  were  seized  with  convulsions.  In  some  animals  opisthotonic 
convulsions  occurred,  and  in  some  spastic  rigidity.  In  man  only  the  ex- 
citement stage  with  exhilaration  has  been  attained,  as  it  is  probable  that 
the  toxic  dose  of  cocaine  is  for  man  very  large.  [A  large  dose  first  stim- 
ulates, and  then  paralyzes  the  sensory  and  motor  nerves,  the  sensory  be- 
ing more  affected  than  the  motor.  The  spinal  cord,  Ott  finds,  is  similarly 
affected.]  As  much  as  twenty  grains  have  been  taken  without  any  harm- 
ful result.     It  kills  by  causing  cessation  of  respiration. 

Upon  the  circulation  cocaine  acts  in  two  ways :  it  constricts  the  ves- 
sels, and  so  increases  arterial  pressure,  while  it  stimulates  the  heart.  The 
last-mentioned  effect  passes  off  before  the  contraction  of  the  vessels  dis- 
appears. 

[The  contraction  of  the  blood,  induced  by  either  topical  or  general 
administration,  is  followed  by  dilatation,  and  if  a  large  quantity  is  used. 


m 


COCAIJN^E.  437 

dilatation  at  once  ensues  of  the  arteries,  capillaries,  and  veins.  This 
primary  dilatation  lasts  about  six  minutes,  and  is  followed  by  contraction 
for  about  the  same  space  of  time.  Weak  doses,  liypodermfcally  admin- 
istered, contract  the  vessels  for  a  short  time,  dilatation  beginning  in 
about  ten  minutes,  and  continuing  for  three  quarters  of  an  hour  (Kriiger). 
The  contraction  of  the  vessels  is  ascribed  to  stimulation  of  the  vaso- 
motor centre,  as  section  of  the  spinal  cord  prevents  a  rise  of  blood  press- 
ure. Small  doses  accelerate  the  pulse,  large  doses  slow  the  pulse.  A 
full  dose,  as  of  half  to  three  quarters  of  a  grain,  given  hypodermically, 
accelerates  the  pulse  to  120,  or  130,  or  l-iO  beats  per  minute,  and  makes 
it  irregular.] 

Cocaine  exerts  a  modifying  effect  upon  the  secretions.  It  lessens  the 
production  of  saliva,  gastric  juice,  tears,  and,  it  is  said,  also  of  perspira- 
tion. 

The  peristaltic  movements  of  the  intestines  are  at  first  increased,  but  at 
length  become  sluggish,  and  then  paralysis  occurs.  This  explains  the  fact 
tliat  several  authorities  speak  of  cocaine  as  acting  mildly  upon  the  bowels, 
while,  as  was  stated  above,  those  who  abuse  it  by  excess  suffer  from  con- 
stipation and  dyspepsia. 

The  action  of  cocaine  upon  the  muscular  system  is  at  present  uncer- 
tain, for  while  Nikolsky  and  Yon  Anrep  expressly  state  the  muscles  are 
unaffected,  Ott  and  Biichheim  and  Eisenmenger  describe  its  behavior  as 
presenting  a  parallel  to  that  of  veratrine. 

The  quantity  of  urine  is  lessened,  as  is  the  amount  of  urea  excreted, 
and  this,  coupled  with  its  general  behavior  in  supporting  the  body  under 
fatigue  and  low  diet,  would  suggest  that  it  possesses  the  power  of  staying 
tissue  change  throughout  the  body. 

A  slight  rise  in  the  general  temjjerature  occurs  under  cocaine  adminis- 
tration, large  doses  are  said  to  raise  the  rectal  temperature  considerably, 
but  as  a  rule  this  is  preceded  hj  an  initial  depression.  In  poisoning  by 
cocaine  the  rectal  temperature  becomes  subnormal  Ijefore  death. 

Elimination  of  the  drug  takes  place  probably  by  the  kidneys,  and  it  is 
often  accompanied  by  the  production  of  albumen  and  sugar  in  the  urine. 
Von  Anrep  regards  these  as  resulting  from  the  asphyxia  caused  by  the 
cocaine's  paralyzing  action  on  the  respiratory  muscles,  and  not  from  any 
direct  action  of  the  alkaloid. 

All  observers  appear  to  agree  that  the  intellect  remains  unaffected 
save  by  way  of  exhilaration  or  depression. 

Upon  the  pupil  cocaine  possesssed  a  marked  mydriatic  effect.  This 
begins  to  show  itself  in  from  ten  to  twenty  minutes  after  dropping  the 
solution  upon  the  conjunctiva,  and  it  reaches  a  maximum  in  half  an  hour, 
l^ersisting  for  another  half  hour,  and  then  gradually  disappearing.  Al- 
though, according  to  Dr.  Knapp,  of  New  York,  cocaine  dilates  the  pupil 
as  much  as  atropin,  its  effects  pass  off  very  much  more  rapidly;  and 
further,  it  reduces  the  power  of  accommodation,  while  it  does  not  wholly 
do  away  with  it.  Even  before  the  dilatation  has  ceased  the  power  of  ac- 
commodation returns  in  full  force.  It  seems  that  the  range  of  accommo- 
dation is  shortened  by  moving  the  near  point  from  the  e3^e,  but  the  far 
point  is  not  appreciably  affected.  Together  with  this  mydriatic  action, 
cocaine,  as  Roller  first  pointed  out,  renders  the  conjunctival  and  sub- 
conjunctival tissues  wholly  insensitive  to  pain,  so  that  cauterizing,  cutting, 
etc.,  may  be  performed  with  impunity,  so  long  as  the  deep  structures  are 
not  invaded. 


438  COCAINE. 

The  employment  of  hydrochlorate  of  cocaine  as  an  anfestlictic  hi 
ophthalmic  practice  has  now  received  ample  trial,  and  has  been  well 
spoken  of  by  the  leading  ophthalmic  surgeons,  both  at  home  and  abroad. 
A  four  per  cent,  solution  is  instilled  into  the  conjunctiva,  three  or  four 
times  at  intervals  of  five  minutes.  When  the  conjunctiva  can  be  picked 
\\\)  without  the  patient's  experiencing  any  discomfort  the  operation  may 
be  proceeded  with.  In  this  way  iridectomies,  extractions  and  operative 
measures  dealing  with  the  conjunctiva  are  rendered  painless,  although  in 
some  cases  section  of  the  iris  occasions  momentary  pain.  Dr.  Keyser  has 
met  with  several  cases  of  panophthalmitis  which  ensued  upon  operation 
being  performed  upon  cocainized  eyes,  and  he  attributes  this  unhappy 
result  to  the  cocaine.  Such  cases,  however,  would  appear  to  be  very  rare. 
A  further  evil  consequence,  alleged  to  have  followed  the  use  of  hydro- 
chlorate  as  a  mydriatic,  is  the  supervention  of  yellow  opacity  of  cornea. 
This  discoloration  was  speedily  got  rid  of  when  atropin  was  used  in  place 
of  cocaine. 

In  operations  for  squint,  it  is  not  sufficient  simply  to  instil  the  cocaine. 
A  few  drops  of  a  four  per  cent,  solution  are  injected  by  a  fine  hypodermic 
syringe  through  the  cocainized  conjunctiva  into  the  muscle  which  it  is 
desired  to  tenotomize.  Mr.  Walter  Jessop  adopted  a  similar  plan  to 
produce  antesthesia  of  the  canaliculi,  and  was  able  to  slit  them  up  with- 
out giving  any  pain.  The  same  surgeon  cautions  against  cocaine  in  cases 
in  which  it  is  requisite  to  remove  foreign  bodies  from  the  cornea,  as  it 
renders  that  structure  so  flaccid  that  operative  measures  become  very 
difficult,  and  unless  great  care  is  taken  serious  abrasion  of  the  corneal 
surface  may  be  caused. 

In  the  treatment  of  glaucoma  by  section  of  the  iris  cocaine  fails,  unless 
it  is  injected  into  the  anterior  chamber.  Mr.  Jessop  has  used  with 
success  a  small  steel  bent  cutting  needle,  the  stem  being  bored  and  made 
to  fit  a  hypodermic  syringe.  Excision  of  the  eye  in  most  cases  in  which 
cocaine  was  used  proved  painful,  at  all  events  during  the  last  stages,  when 
the  deep  structures  were  divided.  It  is  well  in  preparing  for  these  opera- 
tions to  -inject  hypodermically  both  the  sub-conjunctival  and  subfacial 
tissues.  The  photophobia  ensuing  upon  corneal  ulcers  or  other  causes  is 
relieved  completely  by  instillations  of  a  four  per  cent,  solution  of  the 
hydrochlorate  of  cocaine.  Mr.  Frank  Hodges,  of  Leicester,  has  pointed 
out  the  peculiar  merit  of  cocaine  in  deep  wounds  of  the  cornea,  or  sclerot- 
ic. To  remedy  such  laceration  very  painful  manipulation  is  needful, 
and  the  employment  of  a  general  anesthetic  might,  he  points  out,  cause 
struggling,  and  so  lead  to  loss  of  vitreous,  whereeas,  under  the  influence 
of  cocaine,  the  patient  remains  quite  still,  feels  no  pain,  and  can  assist  ^_L 
the  operator  by  moving  his  eye  in  any  required  position.  When  it  is  de-  ^^H 
sired  to  obtain  an  anesthetic  without  a  mydriatic  eifect,  it  is  necessary  to  ^^ 
combine  pilocarpine  with  the  cocaine.  Dr.  Bradford  employed  ten  drops 
of  a  five  per  cent,  solution  of  pilocarpine  to  a  drachm  of  a  four  per  cent, 
solution  of  hydrochlorate  of  cocaine  and  found  it  answered  admirably. 

A  convenient  method  of  using  cocaine  is  in  the  form  of  the  officinal 
discs,  which  are  composed  of  gelatine,  glycerine,  and  ^^gr.  of  hydrochlo- 
rate of  cocaine.  Placed  beneath  the  eyelid  while  the  lids  are  closed,  it 
soon  exerts  its  influence.  In  prolonged  operations  about  the  eye,  it  is 
necessary  to  repeat  the  dose  of  cocaine  at  intervals,  and  this  is  easily  done 
by  using  a  drop  bottle.  A  jieculiarity  in  the  eff'ect  produced  by  cocaine, 
and  pointed  out  by  Koenigstein  of  Vienna,  is  that  a  certain  amount  of 


COCAINE.  439 

exoplithalmos  follows  its  topical  application  to  the  eye,  but  soon  passes 
off  and  leaves  no  untoward  consequences.  The  fundus  oculi  is  unaffected, 
nor  is  the  intra-ocular  tension  altered  by  the  use  of  cocaine.  Another 
useful  method  of  applying  this  anesthetic  is  to  combine  it  with  vaseline, 
making  a  five  per  cent,  ointment  and  smearing  it  over  the  part  to  be  ren- 
dered insensitive. 

[A  three  per  cent,  solution  may  cause  exfoliation  of  the  corneal  epithe- 
lium or  chronic  interstitial  keratitis  and  panophthalmitis.] 

In  examinations  and  operations  about  the  larynx,  cocaine  has  been 
employed  for  some  considerable  time.  Dr.  Semon  recommends  painting 
the  larynx,  uvula,  and  neighboring  parts  with  a  twenty  per  cent,  solu- 
tion. This  not  only  enables  the  surgeon  to  obtain  a  good  view  of  the 
jDarts,  but  allows  the  painless  removal  of  polypi  and  other  growths.  The 
ojjeration  can  be  performed  in  five  or  ten  minutes  after  this  application. 

For  the  treatment  of  ulcerations  on  the  epiglottis,  whether  tubercu- 
lar or  otherwise,  painting  with  a  twenty  per  cent,  solution  is  very  useful, 
and  a  like  application  is  of  singular  service  in  acute  and  chronic  laryngi- 
tis. Dr.  Neale  states  that  the  small  operation  of  removing  the  uvula  can 
be  accomplished  painlessly,  if  the  part  be  painted  once  or  twice  with  a 
two  per  cent,  solution. 

Tonsillitis  is  relieved  in  two  ways  by  the  use  of  a  four  per  cent,  solu- 
tion of  the  hydrochlorate  painted  over  the  tonsils;  the  patients  are  able 
to  swallow  without  difficulty,  and  their  pain  is  assuaged.  It  is  necessary 
to  repeat  the  application  every  hour  or  so  according  as  the  pain  returns 
or  not.  Xo  fear  need  be  entertained  of  toxic  symptoms  appearing,  as  co- 
caine appears  not  to  have  ax3umulative  action.  In  other  forms  of  dys- 
phagia cocaine  painted  over  the  pharyngeal  mucous  membrane  is  very 
serviceable. 

[It  is  sometimes  administered  as  spray  in  throat  diseases.  Forty 
minims  of  four  per  cent,  solution  employed  in  this  way  has  induced 
serious  symptoms;  headache,  giddiness,  flushed  face,  dryness  and  con- 
striction of  the  throat,  widely  dilated  pupils,  slow  respiration  and  rapid 
pulse,  with  some  cyanosis.  Kapidly  inhaled  and  rapidly  absorbed  by  the 
lungs,  it  is  conveyed  in  a  concenti'ated  state  to  the  heart.] 

According  to  Dr.  Bosworth  and  others,  painting  the  nasal  mucous 
membrane  with  a  twenty  per  cent,  solution  greatly  relieves  hay  fever, 
and  removes  its  paroxysms.  Dr.  Paget,  of  Great  Crosby,  finds  a  four  per 
cent,  solution  efficacious;  he  directs  that  a  few  drops  should  be  allowed 
to  fall  into  the  nostril  and  be  sniffed  up  Avhile  the  head  is  held  well 
back.  In  all  cases  it  is  important  to  dry  the  mucous  membrane,  as  far  as 
possible,  before  the  application  is  made.  Acute  coryza  in  its  early  stage 
may,  it  is  said,  be  completely  arrested  if  the  nasal  mucous  membrane  is 
painted  with  cocaine. 

When  cocaine  is  painted  over  the  mucous  membrane  lining  the  mea- 
tuses of  the  nose,  it  causes  a  marked  constriction  of  the  parts,  so  that 
the  mucous  membrane  clings  closely  to  the  bony  framework.  This  pecul- 
iarity is  of  great  service  in  anterior  tnid  posterior  rhinoscopy.  Mr. 
Cresswell  Baber  recommends  the  use  of  cocaine  when  there  is  undue 
erection  of  the  turbinate  bones,  and  also  for  hemorrhage  from  the  nasal 
mucous  membrane.  Oj)erative  measures  which  involve  the  deeper  nasal 
structures  as  a  rule  require  a  general  anesthetic;  but  some  successful  cases 
are  reported  in  which  pledgets  of  absorbent  cotton-wool  soaked  in  cocaine 
hydrochlorate  twenty  per  cent,  were  sufficient  to  render  the  structures 


440  cocArsTE. 

anaesthetic.  It  is  necessary  to  delay  the  operation  in  order  to  reapply 
the  cocaine  plugs  from  time  to  time. 

[Cocaine  hydrochlorate  is  useful  in  psoriasis  of  the  tongue;  thus  a 
tabloid  sucked  just  before  a  meal  averts  the  pain  from  the  jiassage  of 
the  food.] 

According  to  Dr.  Henry  Keden,  an  atomizer  containing  a  four  per 
cent,  solution  of  the  hydrochlorate,  is  a  sure  means  of  curing  otalgia. 
He  directs  the  patient  to  inhale  vigorously,  then  by  closing  the  lips  and 
expanding  the  cheeks  to  force  the  spray  up  the  Eustachian  tubes. 
This  plan  he  supplements  by  spraying  the  tympanic  membrane  through 
the  external  meatus.  The  inhalation  was  repeated  every  three  minutes. 
Perhaps  a  better  plan  is  to  pass  a  Eustachian  catheter  and  inject  a  fe^y 
drops  of  a  two  per  cent,  solution,  taking  care  to  warm  it  beforehand. 

Dr.  Weld,  of  New  York,  paints  the  gums  Avith  a  ten  per  cent,  solution 
before  removing  tartar  from  the  teeth,  and  in  dealing  with  a  sensitive 
tooth  pulp,  Merck's  method  of  working  up  a  little  of  the  hydrochlorate, 
or,  better,  the  citrate,  into  a  pill,  and  pressing  it  into  the  jminful  cavity, 
is  highly  satisfactory.  It  may  also  be  applied  by  small  cotton-wool  plugs 
soaked  fn  a  twenty  per  cent,  solution.  Fissures,  ulcers,  and  painful  swell- 
ings on  the  tongue,  lips,  and  mucous  membrane  of  the  cheeks  cease  to 
give  trouble  after  painting  with  cocaine.  As  it  does  not  cure  the  condi- 
tion, the  pain  will  return  unless  frequent  paintings  be  had  resort  to. 

Upon  the  urino-generative  tract  cocaine  exerts  most  benign  effects. 
The  injection  of  a  few  drops  of  a  two  per  cent,  solution  into  the  urethra 
relieves  the  pain  and  smarting  of  acute  gonorrhoea.  The  injection,  which 
must  not  be  made  with  alcohol,  should  be  retained  for  a  few  minutes,  and 
repeated  before  micturition  is  attempted.  It  is  said  to  shorten  the  dura- 
tion of  the  urethritis.  A  similar  manoeuvre  may  be  tried  before  catheter- 
ization, in  cases  in  which  instruments  are  badly  borne.  When  a  stricture 
is  jDresent.  it  is  often  difficult  to  render  the  urethra  insensitive  beyond  it. 
An  injection  of  four  per  cent,  is  highly  spoken  of  in  irritable  bladder. 
tSmall  cotton-wool  tampons  soaked  with  a  two  per  cent,  solution  relieve 
the  burning  pain  of  blenorrhcea. 

In  some  cases  a  five  per  cent,  ointment  proves  more  serviceable.  The 
intense  suffering  caused  by  the  itching  of  scrotal  eczema  yields  at  once  to 
a  lotion  of  cocaine.  Pruritus  ani  and  of  the  pudendum  and  vaginismus 
are  also  relieved,  although  of  course  it  is  necessary  to  ascertain  and  re- 
move the  cause  of  these  painful  conditions. 

Dr.  Symes,  who  recommends  suppositories  and  pessaries  for  the  relief 
of  painful  conditions  about  the  rectum  and  vagimi,  cautions  that  the 
former  should  not  exceed  five  grains,  the  latter  not  fifteen  grains,  as 
dilution  of  cocaine  considerably  lessens  its  activity. 

Dr.  Adelberg  Weiss,  of  Vienna,  was  able  to  allay  the  agonizing  jDain 
of  extensive  scalding  by  painting  the  skin  with  cocaine  lotion. 

As  a  hypodermic  injection  the  hydrochlorate  of  cocaine  2:)roves  useful 
in  the  treatment  of  various  forms  of  neuralgia.  For  this  purpose  not 
more  than  a  third  or  half  a  grain  should  be  employed,  and  the  injection 
must  be  practiced  in  the  course  of  the  nerve. 

[It  is  better  to  begin  with  even  a  smaller  dose,  as  the  susceptil)ility  to 
the  drug  varies  in  different  persons.  I  have  seen  the  hypodermic  injec- 
tion afford  great  relief  for  several  hours  in  cases  of  severe  neuralgia.  It 
is  especially  useful  for  patients  who  are  disagreeably  affected  by  hypo- 
dermic injections  of    mor^jhia;    often  the  patients  experience  a  very 


CINCHONA.  441 

pleasant  stimulation,  which  they  compare  to  the  effects  of  champagne,  and 
so  exhilarafing  is  the  result  sometimes  that  they  are  very  reluctant  to 
discontinue  the  drug.] 

Merck  has  prepared  an  artificial  cocaine  from  benzoyl-ecgonin. 

The  salts  of  cocaine  have  been  employed  internally  for  their  action 
upon  the  heart  and  nervous  system.  Thus  Dr.  Hicks,  of  New  York, 
found  doses  of  cocaine  relieved  the  dyspnoea  due  to  weakened  respiratory 
action.  He  also  found  benefit  followed  its  use  in  cases  of  palpitation 
when  a  weakened  heart,  although  free  from  valvular  lesions,  had  become 
dilated  and  atonic.  One-half  a  grain  alleviates  these  symptoms,  and  proves 
serviceable  in  nervous  exhaustion  and  sick  headaches.  In  the  treatment 
of  alcohol  craving  and  the  morphia  habit,  cocaine  has  by  many  careful 
observers  been  pronounced  of  great  benefit.  It  restores  the  appetite,  in- 
duces sleep,  and  promotes  digestion,  while  it  soothes  the  brain  and  induces 
a  feeling  of  contentment  and  calm. 

[Given  in  the  form  of  a  pill,  cocaine  sometimes  eases  painful  affec- 
tion of  the  stomach,  and  averts  vomiting.  It  is  sometimes  useful  in  the 
vomiting  of  pregnancy,  and  maybe  taken  by  the  mouth,  administered 
hypodermically,  or  applied  to  the  os  uteri. 

An  electrical  current  assists  the  absorption  of  cocaine,  like  other 
alkaloids.  The  positive  pole  sliould  be  dipped  in  a  solution  of  cocaine 
hydrochlorate  and  applied  to  the  skin,  which  speedily  becomes  ana3sthetic. 

Administered  as  an  anal  injection  or  suppository,  it  checks  the  diar- 
rlioea  and  straining  of  dysentery.  Cocaine  is  useful  in  pruritus  ani,  and 
in  itching  diseases  of  the  skin,  like  eczema.] 

Cocaine  hydrochlorate,  when  kept  in  solution  is  liable  to  uiidergo 
changes,  and  a  fungus  appears  upon  the  surface,  rendering  the  solution 
irritating  and  unfit  for  use.  The  addition  of  -jj-^  of  a  grain  of  salicylic 
acid  preserves  the  cocaine,  but  renders  its  solution  rather  irritating,  and 
so  should  not  be  used  in  ophthalmic  practice.  Holz  has  found  ten-minim 
doses  of  a  three  per  cent,  solution,  given  three  times  in  twenty-four  hours, 
useful  in  the  vomiting  of  pregnancy;  and  Dr.  Si^riman  claims  that  benefit 
follows  a  quarter  of  a  grain  in  nervous  dyspepsia,  given  three  or  four 
times  a  day  in  milk  or  coffee. 


CINCHONA  AND  ITS  ALKALOIDS. 

Salts  of  quiniaare  protoplasmic  poisons,  arresting  amoeboid  and  the 
allied  movements  of  the  white  corpuscles.  Even  weak  solutions  are  highly 
poisonous  to  protozoa  and  infusoria  (Binz),  more  so  even  than  salts  of 
strychnia  or  morphia.  Small  quantities  of  quinia  salts  destroy  septic 
germs  and  arrest  putrefaction  more  thoroughly  than  most  antiseptics, 
including  even  arsenic  and  creasote.  Quinia  is  not  equally  destructive 
of  all  micro-organisms ;  those  of  septic  fluids  resist  its  action  to  a  great 
extent.  Moreover,  with  the  exception  of  strychnia,  quinia  hinders 
alcoholic  and  butyric  fermentations  in  greater  degree  than  other  bittere. 
It  does  not  prevent  the  action  of  ptyalin  on  starch,  nor  the  conversion  of 
amygdalin  into  oil  of  bitter  almonds.  Cinchona  possesses  the  same  prop- 
erties, but  in  a  weaker  degree  than  quinia. 

Powdered  bark   contains,  besides   various  alkaloids,  a  considerable 


442  CINCHONA. 

quantity  of  tannin,  a  fact  to  be  borne  in  mind  when  we  administer  bark, 
or  any  of  its  preparations. 

Finely  poAvdered  bark  dusted  thickly  over  foul,  indolent,  sloughing, 
and  even  gangrenous  ulcers,  and  left  to  form  a  kind  of  poultice,  has  ajD- 
parently  promoted  the  healing  process.  Hospital  gangrene,  too,  has 
been  successfully  treated  in  this  way. 

Bark  has  been  employed  as  a  dusting  powder  to  check  profuse  forma- 
tion of  pus,  mucus,  or  the  secretion  of  eczema. 

Quinia  is  employed  in  the  form  of  spray,  and  as  a  strong  solution 
applied  topically  to  the  throat  in  diphtheria. 

Since  its  adoption  by  Helmholtz  solutions  of  quinia  are  employed  to 
flush  the  nose  in  hay  fever.  This  treatment  succeeds  in  some  cases,  but 
in  others  fails  completely. 

Dr.  Currie  finds  that  he  can  always  arrest  excessive  sweating  by  bath- 
ing the  skin  with  a  solution  of  alcohol  (a  pint)  and  quinine  (a  drachm). 

Cinchona  bark  audits  preparations  are  bitter  to  the  taste,  and,  like  all 
bitter  substances,  stimulate  temporarily  the  salivary  glands.  The  tannin 
of  the  bark  precii^itates  the  mucus  of  the  mouth,  and  acts  likewise  as  an 
astringent  to  the  mucous  membrane  itself. 

The  alkaloids,  when  swallowed  in  an  insoluble  form,  combine  with 
the  acids  of  the  gastric  juice  and  become  soluble,  so  that  as  a  mere  solv- 
ent it  is  unnecessary  to  administer  quinia  and  cinchona  with  acids.  A 
large  dose  merely  suspended  in  fluid  is  far  less  bitter  than  when  dissolved. 

The  taste  of  quinia  can  be  concealed  by  adding  an  equal  quantity  of 
powdered  ginger  to  the  quinia.  Milk,  too,  covers  the  taste  of  quinine. 
When  large  doses,  as  forty  grains,  are  administered,  it  is  better  to  give 
it  in  pill,  otherwise  it  may  cause  sickness. 

The  alkaloids  of  bark  probably  undergo  no  other  change  in  the  stomiich 
than  that  just  mentioned.  Their  action  in  the  digestive  tract  is  similar 
to  that  of  bitters  generally,  being  slight  irritants  to  the  mucous  mem- 
brane, and  so  producing,  both  in  the  mouth  and  stomach,  an  increase  of 
mucus.  It  is  generally  stated  that  cinchona  increases  the  amount  of  the 
gastric  juice  for  a  short  time  to  a  small  extent,  and  further  experiments 
show  that  cinchona  and  its  alkaloids  check  the  action  of  the  gastric  juice 
on  the  food,  and  check  also  fermentations,  as  that  of  sugar  by  yeast.  It 
appears,  therefore,  that  cinchona  increases  for  a  short  time  the  produc- 
tion of  both  saliva  and  gastric  juice,  and  so  in  a  small  measure  may  aid 
digestion;  that  it  is  an  irritant  to  the  mucous  membrane,  and  promotes 
the  secretion  of  the  mucus  of  the  mouth  and  stomach;  and  that  it 
checks  the  digestive  action  of  the  gastric  juice  and  fermentation. 

Thus  our  theoretical  knowledge  would  appear  to  show  that  quinia 
neither  increases  appetite  when  the  stomach  is  healthy  nor  aids  in  any 
marked  degree  digestion;  yet  exiDcrience  fails  to  support  these  views; 
for,  even  when  the  stomach  appears  to  be  healthy,  quinine  certainly  seems 
to  sharpen  appetite  and  assist  digestion,  especially  in  general  debility. 

These  substances  are  useful  to  check  unhealthy  or  excessive  fermen- 
tation in  the  digestive  canal. 

These  alkaloids  if  too  long  employed  disorder  the  stomach,  producing 
heat  and  weight  at  the  epigastrium,  loss  of  appetite,  nausea,  sickness,  and 
even  diarrhoea.  Poisonous  doses  excite  great  thirst,  burning  pain  at  the 
epigastrium,  and  vomiting. 

Quinine  appears  to  exert  no  influence  on  the  secretion  of  bile. 

It  is  given  with  benefit  in  cases  of   worms;  but   as   decoction    of 


1 


CINCHONA.  44  :> 

cinchona  appears  to  have  no  direct  influence  on  ascarides  and  taeniae,  the 
good  effects  of  quinia  must  be  due  to  its  beneficial  effect  on  the  mucous 
membrane,  by  preventing  the  production  of  the  abundant  mucus,  which 
favors  the  development  and  growth  of  these  worms. 

When  quinia  is  taken  in  large  quantities  some  of  it  is  said  to  pass  off 
with  the  fffices, 

Quinia  reudily  passes  into  the  blood,  and  as  it  can  be  detected  un- 
changed in  the  urine,  sweat  and  secretioiis  of  healthy  persons  and  fever 
patients,  probably  very  little  undergoes  decomposition  in  the  body.  It  is 
almost  exclusively  eliminated  by  the  urine,  most  of  it  being  excreted  in 
six  hours. 

Quinia  lessens  the  power  of  haemoglobin  to  convert  oxygen  into  ozone, 
and  so  lessens  the  ozonizing  action  of  the  blood.     (Binz,  Schntte.) 

Large  doses  affect  the  sight  and  hearing,  excite  subjective  noises,  as 
of  bells  ringing  in  the  ears,  and  occasionally  produce  deafness;  sometimes, 
but  very  rarely,  a  large  dose  destroys  the  sense  of  hearing  for  life;  but 
usually,  in  a  short  time,  possibly  in  a  few  days,  the  noises  cease,  and  the 
hearing  again  becomes  natural.  Large  doses  often  dim  the  sight  and 
sometimes  cause  total  temporary,  rarely  jDermauent,  blindness.  I  have 
noticed  on  some  occasions  that  the  defect  of  vision  is  strangely  limited  to 
one  eye,  or  begins  first  in  one  eye.  The  pupil  of  the  affected  eye  is  very 
generally  dilated,  and  sometimes  to  an  extreme  extent.  Severe  frontal 
headache,  with  dull,  heavy,  tensive,  and  sometimes  agonizing  pains,  are 
some  of  the  most  distressing  and  frequent  symptoms  that  follow  a  large 
dose  of  quinia.  While  these  symptoms  last,  and,  indeed,  generally  before 
they  appear,  the  face  is  flushed,  the  eyes  suffused,  and  the  expression  is 
dull  and  stupid.  Even  small  doses,  in  persons  very  susceptible  to  the 
action  of  this  medicine,  will  produce  some  of  the  foregoing  symptoms, 
especially  the  headache  and  mental  disturbance. 

A  small  dose  of  quinia  in  one  of  my  patients  always  bring-s  ovit  a  uniform  red  rash 
over  the  whole  body,  most  marked  on  the  back  of  the  neck,  accompanied  by  very 
severe  stinging  pain,  especially  on  the  nape,  and  in  the  clefts  between  the  fingers. 
Desquamation,  as  free  as  after  a  sharp  attack  of  scarlet  fever,  always  follows  the 
rash. 

In  some  people  quinia  produces  larg'e  patches  of  erythema  with  great  irrita- 
tion, gastric  disturbances,  and  accelerated  pulse.  A  patient  tells  me  that  even 
small  doses  always  excite  violent  urticaria,  her  face  swelling  till  she  can  scarcely 
see.  She  is  so  intolerant  of  this  drug  that  a  quinine  hair-wash  brought  out  a 
crop  of  urticaria  on  her  head,  and  a  tooth-powder,  containing  a  small  quantity  of 
quinine,  caused  her  lips  and  gums  to  swell. 

Many  of  the  foregoing  symptoms  no  doubt  are  due  to  the  action  of 
quinia  on  the  brain.  In  toxic  doses  it  excites  convulsions.  Chirone  and 
Curci  find  that  the  removal  of  the  motor  centres  of  the  brain  prevent  these 
convulsions,  and  if  the  central  hemisphere  is  removed  on  one  side  the 
convulsions  are  unilateral.  Albertoni,  on  the  other  hand,  finds  that 
quinia  will  induce  convulsions  when  the  central  hemisphere  or  the  corti- 
cal motor  centres  are  removed. 

Small  doses  increase  the  reflex  action  of  the  spinal  cord ;  larger  doses 
lessen  reflex  action  by  stimitlating  Setschonow's  centre;  and  large  doses 
destroy  the  reflex  function. 

In  large  doses  quinia  depresses  the  heart  by  its  direct  action,  and  prob- 
ably also  the  vaso-motor  centre,  and  hence  diminished  arterial  tension. 

Workers  in  bark  sometimes  suffer  from  a  scaly  papular  eruption,  or 


444  CINCHONA. 

from  a  vesicular  wcejoing  eruption,  and  occasionally  from  great  swelling 
of  the  genitals,  or  of  the  face,  and  eyelids,  with  redness  of  the  eyes.  Tiiey 
sometimes  complain  of  great  itching  of  the  whole  body,  and  it  is  known 
that  quinia  sometimes  produces  urticaria. 

I  find  that,  like  other  antipyretics,  quinia,  when  given  in  toxic  doses, 
does  not  reduce  a  non-febrile  temperature,  and  Dr.  Bartholow  has  con- 
firmed my  experiments. 

•  Kerner  finds  that  quinia  prevents  the  rise  of  temperature  from  active 
physical  exercise,  and  this  is  not  due  to  increased  loss  of  heat  through 
the  skin  by  perspiration,  as  quinia  lessens  perspiration. 

Drs.  Wood  and  Reichert,  however,  show  that  cinchona  alkaloids 
increase  both  heat  formation  and  heat  dissipation,  heat  dissipation  being 
much  in  excess  of  heat  formation.  They  do  not  feel  justified  in  deciding 
which  is  the  cause  of  the  other,  whether  increased  loss  of  heat  induces 
increased  heat  production  or  I'ice  versa. 

Drs.  Cutler  and  Bradford  find  that  quinia  diminishes  the  red  and 
increases  relatively  the  quantity  of  white  corpuscles  of  the  blood. 

Piorry  maintains  that  during  a  fit  of  ague  quinine  at  once  diminished 
the  size  of  the  spleen,  and  it  is  said  that  this  drug  exerts  a  similar  effect 
on  this  organ  during  other  fevers,  and  even  in  health.  Jerusaliewsky 
finds  that  quinia  will  reduce  the  size  of  the  spleen,  even  when  the  nerves 
going  to  the  spleen  are  divided  before  administering  the  drug. 

The  influence  of  cinchona  and  its  alkaloids  on  the  various  forms  of 
intermittent  fever  is  well  known,  controlling  this  formerly  common  com- 
plaint more  effectively  than  any  known  drug.  It  has  been  supposed  to 
check  the  fever  by  its  influence  on  the  spleen;  but,  granting  this  assump- 
tion, it  yet  remains  to  show  how  the  influence  of  the  quinia  on  the  spleen 
prevents  the  return  of  the  fever  paroxysms.  It  jirobably  kills  the  microbe 
on  which  this  disease  depends.  Osier  finds  that  the  infusoria  he  always 
finds  in  the  blood  of  ague  patients  disappear  under  quinine  treatment, 
the  diminution  being  gradual. 

Quinia  generally  arrests  the  disease  at  once.  It  is  well,  however,  to 
bear  in  mind  that  this  remedy  may  dissociate  the  other  symptoms  from 
the  elevation  of  the  temperature;  or,  in  other  words,  it  may  remove  the 
shivering,  sweating,  and  quick  pulse,  while  the  temperature  may  remain 
as  great,  or  nearly  as  great,  as  on  previous  days.  Mere  rest  will  occasion- 
ally effect  the  same  dissociation.  Unless  the  unnatural  elevation  of  tem- 
perature has  been  restrained,  the  paroxysms  will  speedily  return.  This 
fact  it  is  necessary  to  recollect,  otherwise  it  may  be  concluded  that  with 
the  removal  of  the  more  obvious  symptoms  the  disease  itself  is  cured,  and 
thus  the  patient  may  be  i^ermitted  to  return  to  his  usual  avocations. 

A  still  more  curious  circumstance  remains :  that  is,  quinia  may  check 
all  the  symptoms,  even  the  periodical  elevation  of  the  temperature,  and 
yet  about  the  same  time  of  day  that  tiie  series  of  symptoms  were  wont  to 
take  place,  an  increase  in  the  urea  and  urinary  water  may  occur  as  during 
a  severe  paroxysm ;  that  is,  all  the  symptoms  of  the  paroxysm  are  absent, 
except  those  pertaining  to  the  urine. 

I  made  two  experiments  which  tend  to  show  that  quinia,  given  after 
the  commencement  of  the  fit,  is  powerless  to  prevent  the  elevation  of  tem- 
l^erature  of  that  attack,  although  the  drug  may  effectually  prevent  the 
rise  in  succeeding  paroxysms.  It  is  said  that  quinia  subcutaneously 
employed  after  the  paroxysm  has  begun  will  arrest  the  fit.  Some  hold 
that  quinia  is  less  ethcacious  than  the  powdered  bark,  even  when  the  cin- 


CINCHONA.  445 

chona  is  allowed  for;  and  it  is  even  held  that  powdered  bark  is  more  tonic 
than  quinia.  On  the  other  hand,  no  doubt  powdered  bark,  by  reason  of 
its  bulk,  and  of  the  tannin  it  contains,  frequently  upsets  the  stomach. 

There  is  great  variation  of  practice  regarding  the  administration  of 
quinia,  some  giving  small  doses  several  times  daily;  others  preferring  a 
single  large  dose  daily;  both  methods  are  useful,  but  under  different  cir- 
cumstances. In  the  mild  forms  of  ague,  like  those  now  met  with  in  this 
country,  small  doses  several  times  daily  are  sufficient;  but  in  malignant 
forms  large  doses  given  even  several  times  a  day  may  be  required  sum- 
marily to  arrest  the  disease.  Some  say  that  the  drug  should  be  given  at 
the  very  commencement  of  the  fit;  but  this  practice  is  held  to  be  bad, 
by  making  the  immediate  attack  more  severe. 

Trousseau  advised  that  fifteen  grains  should  be  taken  immediately 
after  the  fit,  and  repeated  with  an  interval,  first  of  one,  then  of  two, 
three,  and  four  days,  and  so  on.  Probably  this  is  a  good  means  to  extir- 
pate the  latent  tendency  to  the  disease  and  to  ensure  a  jDcrfect  cure ;  for  it 
must  be  recollected  that,  judging  by  the  temperature,  a  patient  may  un- 
consciously undergo  even  a  severe  fit,  a  fact  proving  the  great  importance 
of  employing  the  thermometer.  Moreover,  Trousseau's  plan  is  judicious;, 
for  even  when  the  quinine  has  removed  all  symptoms  the  patient  is  liable 
to  recurrence  of  the  attack,  from  various  causes,  as  dej^ression  of  the 
health,  or  a  sudden  shock,  as  that  from  an  accident  or  operation;  indeed, 
in  many  instances,  this  tendency  to  ague  lasts  for  years. 

It  is  important  to  recollect  that  the  effect  of  quinia  on  the  fit  bears  no 
relation  to  its  physiological  operation,  either  in  time  or  degree,  for  a  small 
dose  may  prevent  the  occurrence  of  a  fit  otherwise  due  twenty-four  hours 
afterwards,  the  effects  of  the  dose  on  the  system  meanwhile  never  becom- 
ing apparent,  or  having  long  ere  this  passed  quite  away. 

Quinia  is  of  special  use  in  the  malignant  forms  of  ague.  The  dose 
should  be  large,  and  given  in  a  non-febrile  period.  In  these  severe  forms 
of  the  disease  no  circumstances  are  to  be  considered  as  contra-indicating 
its  use.  If  it  cannot  be  borne  by  the  stomach  it  may  be  given  by  the 
rectum,  or  hypodermically.  For  injection  it  is  recommended  to  dissolve 
the  quinine  in  ether,  as  this  solution  is  less  irritating  than  an  acid,  alco- 
holic, or  chloroformic  solvent.  Salts  of  quinidine,  on  account  of  their  sol- 
ubility, have  been  recommended  for  hypodermic  use.  Quinidine  of  com- 
merce is  generally  very  impure.  Dr.  Banking,  and  others,  find  the  hypo- 
dermic method  highly  successful.  Dr.  Banking  has  treated  200  cases 
in  this  way.  He  uses  a  warm  neutral  solution  of  the  sulphate,  1  in  10, 
injecting  five  minims.  On  an  average  three  injections  cure,  the  fever 
being  arrested  on  an  average  in  2.5  days. 

In  remittent  malarial  fever  large  and  often-rejaeated  doses  should  be 
administered  during  the  remission. 

The  more  recent  the  attack  the  sooner  and  more  certainly  will  quinia 
cure. 

It  is  less  efficacious  in  quartan  than  in  other  forms  of  ague,  probably 
because  old  ague  generally  assumes  the  quartan  type.  In  obstinate  cases 
resisting  quinia  arsenic  often  succeeds. 

In  some  cases  where  this  medicine  apjiears  powerless  the  administra- 
tion of  an  emetic  each  morning  sometimes  brings  the  disease  at  once 
under  the  control  of  quinia. 

Quinia  is  used  as  a  preventive  of  ague,  and  in  the  navy  it  is  a  very  use- 
ful  sanitary  precaution,  where  this  fever  prevails,  to  give  sailors  sent 


446  CINCHONA. 

ashore  quinia  before  and  after  landing.  This  preventive  effect  is  forcibly 
illustrated  in  some  observations  recorded  by  Dr.  J.  B.  Hamilton,  of  the 
Royal  Artillery,  who  treated  his  men  with  quinia,  and  but  few  succumbed 
to  ague,  and  those  were  attacked  mildly;  whilst  another  doctor,  disbeliev- 
ing in  the  preventive  action  of  quinia,  allowed  his  men  to  go  unprotected 
by  quinia,  and  a  large  number  were  struck  down  with  fever,  and  several 
died.  Dr.  Hamilton  believes  that  cinchona  is  superior  as  a  pro2:)hylactic 
to  quinia,  and  quinidia  very  inferior  to  quinia. 

The  other  alkaloids  of  bark,  although  inferior  to  quinia,  will  check 
ague.  Cinchona,  it  is  said,  must  be  given  in  doses  one-third  larger  than 
quinia. 

The  Medical  Committee  appointed  by  the  Indian  Grovernment  to  esti- 
mate the  relative  value  of  the  alkaloids,  cinchona,  quinia,  quinidinia,  and 
cinchonidia,  decided  in  favor  of  the  use  of  all  of  them  in  ague.  Natu- 
rally, there  were  individual  differences  of  opinion  concerning  their  exact 
relative  value,  but  all  agreed  that  they  are  all  efficacious  against  ague. 
The  general  opinion  was  that  sulphate  of  quinia  and  sulphate  of  quinidia 
possess  equal  febrifuge  power;  that  sulphate  of  cinchonidia  is  only  slightly 
less  efficacious;  and  that  sulphate  of  cinchona,  though  considerably  in- 
ferior to  the  other  constituents,  is  a  valuable  agent  in  fever. 

It  is  a  fact  well  known  that  in  the  case  of  persons  who  have  encount- 
ered ague,  even  many  years  beforehand,  that  disease  in  them  is  i^rone  to 
take  on  an  intermittent  type,  and  that  in  such  instances  quinia  is  often 
of  great  service. 

Again,  certain  forms  of  neuralgia  not  uncommonly  depend  on  mala- 
rial poison,  and  are  then  apt  to  assume  a  type  distinctly  periodical.  Here 
quinia  in  large  doses,  given  shortly  before  the  expected  attack,  is  highly 
serviceable.  Quinia  often  proves  useful,  too,  in  non-malarial  forms  of 
neuralgia  presenting  this  periodical  character.  Even  when  the  element 
of  i^eriodicity  is  quite  absent  large  doses  of  quinia  often  succeed  in  re- 
moving the  pain  of  this  distressing  malady.  Quinia  is  said  to  control 
neuralgia  and  ordinary  face-ache  more  effectively  when  the  powder  is 
taken  in  minute  quantities  every  fev/  minutes — for  instance,  as  much  as 
will  adhere  to  the  fingers  tip  dipped  into  the  powder. 

It  has  long  been  recognized  that  quinia  has  most  influence  on  neural- 
gia of  the  supra-orbital  branch  of  the  fifth — a  branch  most  often  affected 
with  malarial  neuralgia,  and  non-malarial  periodic-neuralgia;  but  even 
non-periodic  neuralgia  of  this  branch  is  probably  more  amenable  to 
quinia  than  neuralgia  of  the  other  branches  of  the  fifth,  or  of  other  nerves. 

Quinia  is  recommended  in  other  febrile  diseases,  as  ty]3hoid  fever, 
bronchitis,  broncho-pneumonia,  pneumonia,  and  acute  phthisis.  Nu- 
merous observations  J)rove  that  large  doses  effect  a  temporary  reduction 
of  temperature,  occasionally  a  considerable  fall. 

In  Germany,  quinia  treatment,  originally  introduced  by  Vogel,  is 
largely  adoj^ted  i?i  all  fevers,  especially  in  typhoid  fever.  Liebermeister, 
who  follows  him,  gives  large  doses  of  20  to  45  grains  at  nightfall,  so  as  to 
increase  the  morning  fall  down  to  the  normal,  or  nearly  normal,  temper- 
ature. If  the  dose  is  inadequate  to  effect  this,  he  increases  it.  He 
strongly  insists  on  the  necessity  of  giving  the  quinia  in  one  large,  rather 
than  in  several  divided  doses,  as  the  piecemeal  method  has  far  less  effect 
on  the  temperature.  After  very  considerable  experience,  he  avers  that 
he  has  never  seen  these  large  doses  produce  any  injurious  effects,  the  de- 
cline of  the  temperature  usually  beginning  a  few  hours  after  taking  the 


CINCHONA.  447 

medicine,  and  the  minimum  temperature  is  reached  in  from  six  to  twelve 
hours.  The  combination  of  the  cold  bath  with  quinia  is  strongly  recom- 
mended by  some  observers,  as  the  quinia  reduces  the  number  of  baths 
necessary  to  keep  down  the  fever. 

Quinia  is  suj^posed  to  control  inflammation  by  its  destructive  influence 
on  movements  of  the  white  corpuscles,  and  Binz  maintains  that,  after 
irritating  and  inflaming  the  mesentery  by  the  administration  of  quinia, 
the  white  corpuscles  are  killed,  and  their  migrations  are,  by  the  tissues, 
prevented.  It  is  supposed  to  lower  temperature  by  lessening  the  ozoniz- 
ing power  of  the  blood  and  thus  checking  oxidation. 

Quinia  in  large  doses  of  ten  to  thirty  grains  repeated  several  times  a 
day  has  been  recommended  in  rheumatism.  Some  advocate  its  use  at 
the  commencement,  others  at  the  termination  of  the  attack — at  the  com- 
mencement with  the  view  of  shortening  the  course  of  the  attack,  and 
diminishing  the  chance  of  relapsing,  and  at  the  termination  with  the  hope 
of  preventing  the  profound  anaemia  which  so  generally  accompanies  acute 
rheumatism.  Other  authorities  are  altogether  averse  to  the  use  of  this 
drug,  maintaining  that  it  favors  relapses  and  merely  disguises  the  pain, 
and  in  no  degree  shortens  the  attack.  Quinine  is  incomparably  inferior 
to  salicylate  of  soda.  My  experience  is  completely  at  variance  with  the 
statements  relative  to  the  usefulness  of  quinine  in  fever.  No  doubt  a 
sufficient  dose  will  lower  the  febrile  temperature,  and  its  frequent  repeti- 
tion will  keep  the  temperature  normal;  but  at  the  same  time  the  patient 
becomes  greatly  depressed,  and  greatly  inconvenienced  by  deafness,  head- 
ache, loss  of  appetite,  etc.,  so  that  any  advantage  arising  from  the  reduc- 
tion of  the  febrile  temperature  is  more  than  counterbalanced  by  the  toxic 
effects  of  quinine. 

Quinine,  strongly  recommended  by  Corrigan,  is  also  extolled  by  others 
in  pneumonia.  Two  to  three  grains  should  be  given  every  two  or  three 
hours. 

Quinine  has  but  little  effect  in  hyperpyrexia. 

Maragliano,  using  the  hydroplethysmograph  of  Mosso,  finds  that  a 
febrile  temperature  is  preceded  and  accompanied  by  contraction  of  the 
cutaneous  vessels,  and  during  the  decline  of  the  fever  the  vessels  of  the 
skin  dilate.  He  therefore  concludes  that  Traube  is  right  in  attributing 
retention  of  heat  as  one  cause  of  fever;  though  he  regards  increased 
formation  as  another  cause.  Maragliano  finds  that  antipyretics,  as  kairine, 
antipyrine,  thallene,  quinine  salts  and  sodium  salicylate  dilate  the  vessels 
of  the  skin  both  in  fever  and  fever-free  persons,  and  so  increase  the  dis- 
charge of  heat.  They  also  lessen  the  expiration  of  carbonic  acid,  showing 
that  they  also  lessen  the  formation  of  heat. 

Quinia  is  often  given  with  decided  advantage  to  check  the  profuse 
sweating  of  exhausting  chronic  diseases,  such  as  chronic  phthisis.  If  a 
small  dose  fail  to  check  sweating  a  large  dose  of  six  or  eight  grains,  ad- 
ministered at  once,  or  in  portions  repeated  hourly,  sometimes  succeeds. 

In  many  cases  of  profuse  sweating  a  night  draught,  composed  of 
quinia,  sulphate  of  zinc  and  sulphuric  acid,  is  very  useful. 

Quinia  is  sometimes  useful  in  the  vomiting  of  pregnancy.  Many 
American  writers  believe  that  quinia  strengthens  the  contractions  of  the 
womb  during  delivery,  and  some  use  it  in  preference  to  ergot.  Other 
writers  deny  this  action  to  quinia,  but  on  the  rather  inconsequent  ground 
that,  when  given  during  pregnancy,  os  for  ague,  quinia  does  not  induce 
premature  labor,  though  some  writers  have  asserted  the  contrary. 


4-48  SALICINE. 

Quinia  is  often  employed  with  much  benefit  in  diseases  of  mal-nutri- 
tiou,  as  in  impetigo  and  ecthyma.  It  is  also  of  great  benefit  to  the  pale 
and  badly-fed  inhabitants  of  large  populous  towns.  It  is  at  present  un- 
determined whether  its  good  effects  are  dependent  on  its  action  on  the 
stomach  or  on  the  tissues  after  its  absorption  into  the  blood.  Quinia 
has  been  recommended  in  passive  bleeding,  undue  suj^puration,  profuse 
menstruation,  spermatorrhoea,  and  in  excessive  secretion  of  milk.    . 

Quinia  appears  to  be  useful  in  some  cases,  but  quite  useless  in  others, 
of  intermittent  haematuria. 

Some  doctors  highly  recommend  sulphate  of  quinine,  in  five-grain 
doses,  in  lumbago. 

Quinia  is  found  in  the  blood,  which  dissolves  more  of  it  than  water; 
in  the  saliva,  bronchial  mucus,  milk,  and  in  dropsical  effusions.  It  is 
said  to  be  eliminated  slightly  with  the  sweat;  although  Briquet,  after 
giving  large  doses,  could  detect  none. 

Both  quinia  and  cinchona  pass  off'  in  part  by  the  urine,  but  a  i^ortion 
appears  to  be  consumed  in  the  blood,  or  to  be  eliminated  in  some  other 
way.  Kerner  says  that  "a  respiratory  power  of  3,000  c.c.  destroys  fifteen 
grains  of  sulphate  of  quinia  in  twenty-four  hours;  any  amount  over  this 
will  pass  into  the  urine."  Quinia  appears  in  the  urine  of  healthy  indi- 
viduals in  the  course  of  two  to  five  hours,  but  more  quickly  in  young 
than  in  old  persons.  In  some  diseases  (intermittents,  pulmonary  em- 
physema, pneumonia,  morbus  Brightii)  its  exit  is  much  delayed,  and  in 
three  cases  in  which  large  doses  were  given  Dietl  detected  it  in  the  urine 
many  weeks  after  the  last  dose,  showing  that  it  is  not  easily  destroyed  in 
the  body. 

Kerner  finds  that  large  doses  of  quinine  diminish  the  excretion  of 
urea,  uric  acid,  creatine,  phosphoric  and  sulphuric  acids. 

Dr.  Ranke  has  made  the  important  observation  that  a  scruple  of  di- 
sulphate  of  quinia  lessens  by  one-half  the  excretion  or  the  formation  of 
uric  acid,  the  effect  continuing  about  two  days  after  a  single  large  dose, 
the  other  constituents  of  the  urine  remaining  unaffected.  It  would  seem 
likely  that  the  uric  acid  is  not  simply  retained  in  the  system;  for  as  in 
Eanke's  cases,  no  subsequent  increased  excretion  took  place  after  the 
effect  of  the  quinia  had  gone  off;  its  formation  was  absolutely  lessened, 
or  it  must  have  been  converted  into  some  other  substance.  (Parkes  On 
Urine.) 

Certain  circumstances  modify  the  operation  of  the  salts  of  quinia. 
The  physiological  symptoms  appear  early  in  young  people,  who  can  resist 
the  toxical  action  of  the  drug;  but,  on  the  other  hand,  the  effects  of 
quinia  are  more  marked  in  old  people.  Diffusible  stimtilants,  as  wine 
and  coffee,  are  said  to  counteract  the  action  of  quinia. 


SALICINE.     SALICYLIC  ACID.     SALICYLATES. 

Salicylic  acid  is  a  powerful  antiseptic.  Wagner  maintains  that  it 
is  a  more  powerful  disinfectant  of  wounds  than  carbolic  acid.  It  is  said  to 
be  three  times  more  effectual  in  preventing  fermentation  than  carbolic 
acid.     Kolbe  asserts  that  salicylates  possess  no  antiseptic  properties,  the 


SALICINE.  449 

apparent  contradictions  to  this  statement  being  due  to  the  specimen  used 
containing  some  free  acid. 

It  is  often  used  in  j)lace  of  carbolic  acid,  as  an  antiseptic  for  wounds. 
A  four  per  cent,  sohition  is  useful  in  pruritus  and  chronic  urticaria. 
Salicylic  acid  lotions  are  recommended  in  some  cases  of  eczema.  A  one 
per  cent,  solution  in  vaseline  or  oleum  delina  is  useful  in  eczema. 

Salicylic  acid,  given  hyj^odermically,  is  efficacious  in  anthrax;  but  is 
less  effective  than  carbolic  acid. 

Bartholow  recommends  salicylate  of  soda  in  gastralgia  and  fermenta- 
tion in  the  stomach. 

Salicylic  acid  in  large  doses  lowers  blood  pressure.  It  destroys  life 
by  paralyzing  the  respiratory  centre;  others  maintain  by  paralyzing  the 
heart. 

These  substances  in  large  doses  produce  tonic  effects  similar  to  those 
from  quinine. 

In  order  to  produce  any  characteristic  symptoms  by  salicine,  a  single 
large  dose  of  one  drachm  or  more  is  necessary,  or  thirty  grains  repeated 
hourly,  two  or  three  times.  Given  less  frequently,  or  in  smaller  doses, 
it  induces  no  symptoms  whatever.  Toleration  of  the  drug  is  soon  estab- 
lished, so  that  at  last  large  doses  fail  to  i)roduceany  characteristic  effect; 
though  when  given  at  first,  without  any  graduation,  these  full  doses,  even 
after  their  discontinuance,  produce  very  decided  symptoms,  which  may 
persist  one  or  two  days,  and  may  even  become  intensified  the  day  after 
the  withdrawal  of  the  medicine.  The  repetition  of  large  doses  may  pro- 
duce slight  fever,  shown  in  delaying  and  greatly  lessening  the  evening 
normal  diurnal  fall — an  effect  probably  due  to  irritation  of  the  stomach. 

Smaller  doses  of  salicylate  of  soda  are  sufficient  to  induce  toxic  effects, 
as  from  ten  to  fifteen  grains  every  hour  or  two  hours. 

The  aspect  of  a  patient  under  full  medicinal  doses  is  rather  character- 
istic, being  in  many  respects  similar  to  that  of  a  person  suffering  from 
cinchonism.  The  expression  is  dull  and  heavy,  the  face  quickly  flushes 
on  slight  excitement,  and  the  eyes  become  suffused.  The  flush,  of  rather 
a  dusky  hue,  suffuses  itself  uniformly  over  the  who'le  face.  The  patient, 
-  made  more  or  less  deaf,  often  complains  of  noises  in  the  ears.  He  com- 
plains, too,  of  frontal  headache,  and  his  hands,  when  held  out,  tremble  a 
little.  Ilis  breathing  is  rather  quickened  and  deepened.  Not  unfre- 
quently,  especially  after  large  doses,  nausea  and  vomiting  ensue.  In  some 
cases  one  symptom  may  predominate;  thus  deafness  may  be  almost  com- 
plete, without  headache  or  muscular  trembling,  or  the  breathing  may  be 
characteristic,  and  the  limbs  may  tremble,  without  headache  or  deafness; 
but  it  rarely,  if  ever,  happens  that  any  symptom  is  unaccompanied  with 
the  dull,  heavy  aspect,  and  the  readiness  to  flush.  Under  toxic,  but  not 
dangerous  doses,  the  headache  is  often  very  severe,  so  that  the  patient 
buries  his  head  in  the  pillow.  There  may  be  very  marked  muscular 
weakness  and  tremor,  associated  with  great  muscular  irritability,  so  that 
a  slight  tap,  say  on  the  shoulder,  causes  muscular  contractions  so  strong 
as  to  jerk  the  iirm  backwards.  There  are  often  slight  spasmodic  twitch- 
ings  when  a  limb  is  raised.  Tingling  of  the  extremities  or  other  parts  of 
the  body  sometimes  occur,  the  voice  may  become  thick  and  husky,  the  res- 
piration is  hurried,  sometimes  deepened,  sometimes  sighing  and  shallow, 
and  almost  panting,  as  though  it  were  performed  rather  laboriously;  but 
the  patient  does  not  complain  of  any  difficulty  of  breathing.  When  the 
breathing  is  deep  and  hurried,  both  inspiration  and  expiration  are  often 
29 


450  SALIC  I XE. 

accompanied  by  a  nasal,  sniffing  noise.  The  costal  as  well  as  the  diaphrag- 
matic movements  are  involved  in  the  exaggerated  breathing.  Large 
doses,  often  repeated,  quicken  the  pulse  to  140  joer  minute,  and  it  becomes 
very  weak.  Vision  may  be  aifected,  the  sight  becoming  dim,  and  stra- 
bismus or  ptosis  may  occur — symptoms,  however,  I  have  never  witnessed. 

Patients  taking  salicine  or  salicylates  often  complain  of  great  giddiness 
and  feeling  of  intoxication  on  walking. 

Sometimes  patients  are  made  delirious,  the  delirium  often  closely  re- 
sembling delirium  tremens.  It  may  be  accompanied  Ijy  involuntary  evacu- 
uation  of  urine  and  faeces.  Delirium  is  often  of  the  busy  kind.  In  some 
cases  when  salicylate  of  soda  has  excited  delirium,  if  the  drug  be  discon- 
tinued and  in  a  short  time  repeated,  it  does  not  the  second  time  j^roduce 
delirium. 

Salicylate  of  soda  sometimes  excites  acute  ne]3hritis,  with  bloody 
albuminous  urine  containing  casts. 

In  addition,  these  substances  sometimes  produce  sickness,  and  more 
rarely  diarrhoea,  so  that  they  cannot  be  continued;  and  further,  salicylic 
acid  often  causes  much  distressing  burning  of  the  throat.  When  admin- 
istered in  fever,  salicylic  acid  and  salicylates  not  uncommonly  excite  very 
abundant  perspiration,  but  this  did  not  occur  in  our  experiments  on 
healthy  persons.  While  administering  these  remedies  in  rheumatic  fever, 
some  observers  have  seen  them  produce  an  urticarial  or  vesicular  erup- 
tion. These  symptoms,  Strieker  asserts,  appear  sooner  in  old  and  feeble 
than  in  young  and  vigorous  people.  Dr.  Dreschfeld  describes  the  case 
of  a  patient  suffering  from  diphtheritic  nephritis,  in  whom  salicylate  of 
sodmm  caused  rigor,  fever,  a  temperature  of  103°,  frequent  pulse,  severe 
headache,  drowsiness,  dry  brown  tongue,  nausea  and  vomiting,  an  ery- 
thematous rash  on  the  face,  chest,  and  arms,  and  increase  of  splenic  dull- 
ness. I  find  that  salicine  does  not  reduce  a  natural  temperature.  Eiets 
states  that  salicylates  reduce  the  normal  temj^erature  1°  Fah.,  but  I  have 
not  found  this  to  be  the  case. 

Salicine,  salicylic  acid,  and  salicylates,  however,  while  influencing  the 
normal  temperature  but  little  or  not  at  all,  j^owerfully  depress  a  febrile 
temperature,  and  have  been  abundantly  used  for  this  purpose.  With  the 
fall  of  temperature  profuse  perspiration  occurs.  Salicylate  of  soda  is 
now  almost  exclusively  used,  for  it  is  more  soluble  than  salic3dic  acid  and 
cheaper  than  salicine. 

Though  I  have,  on  very  many  occasions,  given  salicine  to  fever  pa- 
tients in  doses  sufficient  to  produce  deafness,  headache,  and  muscular 
tremor,  I  have  never  seen  it  induce  the  quick  and  great  reduction  of 
temperature  which  follows  the  use  of  salicylic  acid. 

Salicylate  of  soda  is  not  much  used  now  as  an  antipyretic  in  acute 
specific  or  inflammatory  fevers,  for  though  no  doubt  it  will  hold  down 
the  temperature,  it  generally  does  more  harm  than  good  by  the  depression 
and  discomfort  it  produces,  and  whilst  in  sufficient  doses  capable  of  hold- 
ing down  the  fever  temperature,  it  does  not  shorten  the  course  of  the 
disease. 

These  substances,  however,  are  most  valuable  in  acute  rheumatic  fever. 
Dr.  Maclagan,  in  this  country,  and  Dr.  Senator,  of  Berlin,  first  employed 
them  in  this  disease.  Ten  to  fifteen  grains  of  salicylate  of  soda  hourly  is 
generally  sufficient  to  relieve  pain  in  a  few  hours,  and  to  remove  all  fever 
in  three  or  four  days.  Now,  indeed,  we  never  see  cases  of  rheumatic  fever 
running  a  protracted  course  of  one  or  two  months. 


SALICINE.  451 

It  is  a  good  plan  to  give  the  medicine  hourly  till  slight  toxic  effects, 
as  deafness  and  buzzing,  are  induced,  and  then  to  administer  it  every 
two  or  three  hours.  The  effect  is  not  jDrompt  nor  marked  unless  some 
slight  toxic  symptom  is  present. 

It  is  claimed  for  these  remedies  that  they  lessen  heart  complications 
in  rheumatic  fever.  No  exact  observations  have  been  made  on  this  ques- 
tion ;  but,  as  Dr.  Maclagan  observes,  it  is  obvious  that  a  remedy  which 
greatly  shortens  tlie  duration  of  the  disease  must  lessen  the  risk  of  com- 
plications. It  does  not,  however,  afford  perfect  protection  to  the  heart,  as 
several  cases  of  pericarditis  are  recorded  where  this  complication  set  in 
after  the  j)atient  was  well  under  the  drug's  influence.  This,  indeed,  we 
should  expect,  as  the  pericarditis  is  similar  to  the  inflammation  of  the 
joints,  and  while  this  lasts,  risk  of  heart  complication  must  be  en- 
countered. 

I  may  draw  attention  to  a  fallacy  to  which,  I  think,  most  of  the  re- 
porters regarding  these  substances  have  not  paid  sufficient  heed ;  nearly 
all  state  that  in  twenty-four  to  forty-eight  hours  these  agents  exert  a 
marked  influence  on  the  temperature  and  pain.  In  all  the  recorded  cases 
I  have  met  with  the  patients  were  treated  in  hospital,  and  on  admission 
were  at  once  put  under  salicylic  treatment.  Now,  it  is  well  known  that 
the  movement  of  the  Joints  during  the  Journey  to  hospital  considerably 
increases  both  pain  and  fever,  and  that  during  the  first  two  days  in  hos- 
pital the  ixxin  greatly  diminishes,  and  the  temperature  falls  one  or  two 
degrees.  When  the  patients  have  been  at  once  put  under  salicylic  acid 
treatment  this  improvement  in  the  pain  and  fever,  due  to  rest,  has  been 
credited  to  the  drug. 

Acute  rheumatism,  subdued  by  the  salicine  treatment,  is  very  liable 
to  relapse,  and  the  drug,  reduced  in  quantity,  should  be  continued  ten 
days  or  a  fortnight  after  the  temperature  has  become  normal. 

Dr.  Sharkey  and  Dr.  Ord,  and  my  experience  confirms  them,  find  sal- 
icylates of  little  use  in  hyperjoyrexia,  for  this  may  occur  whilst  the  patient 
is  under  the  influence  of  the  drug.  Moreover,  even  when  given  in  full 
doses,  at  the  very  onset  of  the  pyrexia,  it  fails  to  control  it. 

A  solution  of  salicylate  of  soda  applied  to  inflamed  Joints  in  rheuma- 
tism gives  much  relief. 

Salicylate  of  soda  is  very  useful  in  some  forms  of  chronic  rheumatism. 
I  have  not  been  able  to  satisfy  myself  tliat  it  is  of  use  in  rheumatoid 
arthritis,  or  gonorrheal  rheumatism.  If  the  pain  of  chronic  rheumatism 
is  worse  at  night,  then  a  dose  of  thirty  grains  should  be  given  at  bed  time. 
Its  action  is  much  helped  by  adding  a  full  dose,  as  half  a  drachm  to  a 
drachm,  of  citrate  of  soda.   •  It  is  useless  in  gout. 

Salicylate  of  soda,  in  my  exj^erience,  succeeds  better  in  sciatica  than 
any  other  remedy.  Sometimes  its  effects  are  very  prompt,  at  other  times 
it  must  be  continued  for  a  month  or  three  weeks.  It  is  very  useful  in 
lumbago. 

Salicylate  of  soda  is  recommended  in  various  forms  of  neuralgia,  but, 
with  the  exception  of  sciatica,  it  is  certainly  inferior  to  other  remedies. 

It  is  extremely  useful  in  migraine.  Fifteen  to  twenty  grains  will 
generally,  in  a  short  time,  remove  headache,  sickness,  and  the  dull,  stujiid 
feeling  so  often  present  during  these  attacks. 

Several  observers  have  employed  salicylic  acid  in  ague  with  contradic- 
tory results.  Several  obtained  no  benefit,  whilst  others  found  that  it 
cured  a  minority  of  the  cases,  being  most  serviceable  in  recent  cases.     It 


452  SALOL. 

seems  useful  occasionally  as  an  adjuvant  to  quinia,  Sarzance  having 
obtained  good  results  from  a  combination  of  these  remedies. 

Ebstien  and  Julius  Miiller  report  two  cases  of  diabetes  mellitus  cured 
by  salicylate  of  soda.  They  do  not  vaunt  this  remedy  as  a  specific,  but 
the  two'  interesting  cases  they  cite,  after  a  prolonged  trial  of  various 
drugs,  notably  of  carbolic  acid,  got  well  under  the  salicylate  of  soda. 

Da  Costa  employs  salicylic  acid  in  five  grain  doses  to  correct  the  foul 
breath  and  offensive  expectoration  sometimes  occurring  in  jihthisis. 
Berthold,  of  Dresden,  narrates  a  case  which  yielded  promptly  to  salicylic 
acid,  after  the  failure  of  turpentine  inhalations,  and  large  doses  of  quinia. 

Berthold  has  likewise  employed  salicylic  acid  topically  in  "  catarrhal 
stomatitis,*'  and  in  thrush.  He  calls  attention  to  the  ana?sthetic  virtue 
of  the  acid  in  stomatitis,  in  calming  the  gnawing,  burning  pain  of  the 
erosions  after  the  rupture  of  the  vesicles.  The  solution  he  iises  is,  one 
part  of  acid  dissolved  in  sufficient  alcohol,  to  2bO  parts  of  water. 

Salicylic  acid  has  been  used  with  good  results  as  an  injection  (1  to  300) 
in  the  dysenteric  diarrhoea  of  children. 

Salicylate  of  soda  was  first  recommended  in  quinsy  by  Dr.  Hunt. 
It  is  extremely  successful,  shortening  the  disease,  and  almost  always 
preventing  suppuration.  It  is  probably  the  best  remedy  for  quinsy,  ex- 
celling even  aconite  or  guaiacum.  It  should  be  given  in  small  doses,  as 
three  grains  hourly. 

I  have  used  the  following  ointment  in  pruritus  ani  and  vulvge  with 
considerable  success,  though  in  some  cases  it  caused  a  good  deal  of  smart- 
ing:— Acid  salicy.,  3ij;  ol.  theobrom.,  3  v;  cetac,  3iij;  ol.  nucis,  3  jss. 

Salicylic  acid  is  much  used  as  a  local  application  for  corns  and  warts. 
The  following  is  Mr.  Gezou's  formula: — Salicylic  acid,  30  parts;  Ext. 
Cannab.  Ind.,  5  parts;  Collodion,  240  parts.  It  is  applied  with  a 
camel's  hair  brush.  It  is  said  that  the  corn  comes  off  in  four  or  five 
hours,  but  no  doubt  it  is  simply  the  collodion  film  which  peels  off. 

Salicylates  sometimes  produce  rashes,  as  urticaria,  erythema. 

Salicine  and  salicylic  acid  may  be  readily  detected  in  the  urine,  sweat, 
saliva,  and  sputa,  by  the  purple  color  produced  on  the  addition  of  a  drop 
of  the  solution  of  perchloride  of  iron.  It  apj^ears  in  the  urine  in  four  or 
five  hours,  and  seems  to  undergo  speedy  elimination,  though  a  trace  may 
remain  after  four  days'  discontinuance  of  the  medicine. 

It  is  stated  that  these  substances  appear  in  the  urine  in  the  form  of 
salicyluric  acid.  Dr.  Sharkey  detects  salicylic  acid  in  the  urine,  in  the 
serum  from  a  blister,  in  the  expectoration,  but,  strange  to  siy,  not  in 
the  sweat  of  patients  taking  salicylates. 

Dr.  Pye  Smith  points  out  that  the  urine  of  patients  taking  salicylic 
acid  gives  the  reaction  of  sugar  with  Trommer's  test. 

A  little  syrup  of  orange  peel  covers  the  mawkish  taste  of  salicylate 
of  soda.  Twenty  drops  of  hydrobromic  acid  with  each  dose  prevents  the 
buzzing  of  the  ears  produced  by  salicylates.  Bromides  would  act  equally 
well. 


SALOL. 

Salicylic  or  phenic  ether  is  decomposed  in  the  intestine  by  the 
action  of  the  pancreatic  ferment  into  salicylic  acid  and  phenol.     It  con- 


ANTIPYRINE.  453 

tains  about  two-thirds  of  salicylic  acid.  It  is  insoluble  in  water,  and  has 
a  slight  aromatic  taste. 

It  acts  just  like  salicylic  acid,  and  most  observers  ascribe  its  action  to 
the  salicylic  acid  it  contains,  though  some  maintain  that  it  is  more  effica- 
cious than  salicylic  acid  as  an  antiseptic  and  antipyretic. 

As  a  dusting  powder,  diluted  with  an  equal  part  of  talc  or  starch,  it 
is  useful  in  erysipelas.  The  same  powder  sniffed  up  the  nose  removes 
the  fetor  of  oz^ena.  Like  salicylic  acid,  it  has  been  employed  as  an  anti- 
pyretic in  phthisis,  typhoid  fever,  etc.,  and  some  writers  highly  praise  its 
action.  In  my  hands,  like  all  other  antipyretics  yet  introduced,  salol 
has  done  more  harm  than  good,  and  I  gather  that  this  is  the  growing 
opinions  of  others,  as  it  is  now  not  much  used  simjily  as  an  antipyretic. 

It  is  highly  useful  in  acute,  subacute,  and  chronic  rheumatism.  Some 
think  it  mor<:^  efficacious  than  salicylic  acid.  To  me  it  has  appeared  to 
be  valuable,  simply  from  its  component  salicylic  acid.  It  has  to  some 
people  a  less  disagreeable  taste  than  salicylate  of  soda,  and  when  this  salt 
disagrees,  salol  will  often  be  tolerated.  It  produces  the  same  toxic  symp- 
toms as  salicylate  of  soda,  and  in  fact  affects  the  patient  in  all  respects  like 
this  drug.  It  is  useful  also  in  neuralgia  and  lumbago,  and  jDrobably  in 
sciatica. 

It  passes  off  by  the  urine  as  urate  of  salicyl ;  but  some  would  seem  to 
escape  unchanged.  At  least,  the  urine  and  the  breath  strongly  smell  like 
the  powder.  Its  carbolic  acid  causes  carboluria.  It  prevents  decomposi- 
tion of  urine,  and  is  said  to  prevent  decomposition  of  the  urine  in  the 
bladder  in  cystitis,  and  to  keep  it  acid. 

The  dose  is  ten  to  fifteen  grains  hourly.  It  may  be  taken  m  wafer- 
paper,  or  suspended  in  water.  Patients,  I  find,  take  it  easily  m  aerated 
waters.  I  conclude  that  it  acts  simply  as  salicylic  acid,  and  therefore, 
all  the  good  and  evil  partakes  of  salicylate  of  soda,  with  the  one  advantage 
in  taste,  and  in  the  fact  that  it  is  sometimes  tolerated  by  the  stomach 
when  salicylate  of  soda  induces  nausea  and  sickness. 

I  may  here  st.ite  that,  not  uncommonly,  Avhen  sickness  is  induced  by 
large  doses  of  sodium  salicylate,  given  every  three  hours,  an  equivalent 
quantity  given  in  hourly  doses,  is  well  tolerated. 


AIS^TIPYEINE. 


For  some  years  past  therapeutists  have  striven  to  discover  a  drug 
capable  of  reducing  febrile  temperature,  without  causing  any  outward 
symptoms.  Quinine,  salicylate  of  soda,  resorcine,  kairine,  thallin,  etc., 
have  been  employed  for  this  purpose,  but  they  have  been  almost  discon- 
tinued on  account  of  their  disagreeable  and  depressing  effects. 

Filehne  recently  introduced  a  new  substance,  antipyrine,  a  synthet- 
ically prepared  alkaloid  derived  from  chinotine,  and  speaks  most  highly 
of  its  usefulness. 

It  acts  promptly  as  an  antipyretic,  effecting  a  fall  of  several  degrees  in 
two  or  three  hours,  which  often  endures  more  than  twenty-four  hours,  to 
be  followed  by  a  very  gradual  rise,  being  in  this  respect  superior  to  kairine. 


454  ANTIPYRINE. 

The  fall  in  the  pulse  is  not  always  equal  to  the  reduction  of  the  tem- 
perature. With  the  fall  of  the  temperature  the  symptoms  improve,  the 
tongue  grows  clean,  delirium  disappears,  and  restlessness  ceases.  It  inter- 
feres neither  with  the  appetite  nor  the  digestion.  It  produces  generally 
copious  perspiration,  at  other  times  slight  perspiration  and  increased 
secretion  by  the  kidneys.  In  rare  instances  it  excites  vomiting.  It 
sometimes  produces  an  erythematous  rash,  somewhat  like  measles,  leav- 
ing a  brown  stain,  most  marked  on  the  trunk,  the  face  and  upper  part 
of  the  neck  always  remaining  free.  This  rash  disappears  in  spite  of  the 
continued  administration  of  the  drug.  Sometimes  the  rash  is  like  urti- 
caria, sometimes  it  is  hsemorrhagic.  It  may  be  followed  by  desquamation 
(Sara  Welt). 

It  may  cause  some  cardiac  depression,  hence  it  should  be  given  guard- 
edly to  prostrate  patients. 

It  is  said  to  reduce  the  normal  temperature  one  or  two  degrees, 
though  it  has  no  effect  on  the  normal  daily  cycle  of  temperature. 

It  has  been  given  in  typhoid  fever,  pneumonia,  erysipelas,  rheumatic 
fever  and  phthisis. 

It  may  reduce  the  temperature  below  normal,  even  to  93°  F.,  with- 
out producing  any  collapse,  and  it  has  succeeded  where  cold  bath,  quinine, 
and  salicylate  of  soda  have  failed. 

There  is  no  proof  at  present  that  it  shortens  the  disease;  it  appears 
to  be  only  a  sure  and  safe  reducer  of  febrile  temperature. 

Most  observers  recommend  three  hourly  doses  each  of  thirty  grains, 
and  then  to  intermit  the  drug  till  the  temperature  again  rises.  Or, 
smaller  doses,  as  fifteen  grains,  may  be  taken  several  times  a  day. 

At  first  the  accounts  of  its  effects  were  very  enthusiastic,  but  it  is 
much  seldomer  prescribed  than  a  while  ago,  and  after  many  trials,  I 
must  confess  I  find  that,  like  other  antipyretics,  it  causes  so  much  dis- 
tress and  depression  that  in  many  cases  it  does  more  harm  than  good, 
though  I  think  it  is  less  depressing  than  other  antipyretics. 

In  doses  adequate  to  lower  temperature  efficiently  it  often  induces 
vomiting.  The  reduced  temperature,  as  it  rises  again,  when  the  medicine 
is  eliminated,  often  produces  chilliness,  or  even  violent  rigors.  However, 
some  doctors  still  praise  it  highly.  A  single  thirty-grain  dose  given  at 
intervals  of  twelve  or  twenty-four  hours  appears  to  depress  less  than 
smaller  doses  more  frequently  repeated.  It  is  better  to  give  at  first  a 
fifteen  or  twenty-grain  dose  to  test  the  patient's  susceptibility  to  the  drug. 

It  is  maintained  that  antipyrine  is  as  useful  as  salicylate  of  soda  in 
acute  rheumatism.  This  I  am  sure  is  an  error,  and  that  in  this  disease 
antipyrine  cannot  compare  with  salicylate  of  soda.  Antipyrine  will  lower 
the  temperature  like  other  antipyretics,  but  on  discontinuing  the  drug 
the  fever  and  pain  return. 

See  draws  attention  to  its  great  usefulness  in  many  painful  affections, 
as  migraine,  neuralgia,  sciatica,  lumbago,  muscular  rheumatism,  pains  of 
locomotor  ataxy  and  angina  pectoris.  It  should  be  given  in  fifteen-grain 
doses  three  to  six  times  a  day,  or  half  that  dose  twice  as  often.  If  given 
in  doses  larger  than  fifteen  grains,  it  may  cause  methfemoglobinuria.  It 
is  highly  useful  in  migraine;  sometimes  it  succeeds  in  twenty-grain 
doses,  other  patients  require  thirty  grains,  and  in  some  cases  a  twenty- 
grain  dose  must  be  repeated  in  an  hour  or  two  hours. 

See  administers  it  often  hypodermically  to  relieve  pain  in  neuralgia, 
acute  and  chronic  rheumatism,  acute  gout,  biliary  colic,  renal  colic. 


PHENACETIISr.  455 

angina.  It  is  also  useful  in  a  paroxysm  of  asthma,  promoting  expectora- 
tion. It  is  soluble  in  an  equal  quantity  of  water.  Five  to  fourteen 
grains  may  be  administered,  and  if  the  injection  causes  much  pain,  a 
little  hydrochlorate  of  cocaine  should  be  added. 

It  is  recommended  to  relieve  dysmenorrhoea  and  pains  after  delivery; 
also  the  pains  of  parturition,  lessening  the  suffering  without  diminishing 
the  force  of  the  uterine  contractions. 

The  following  is  a  resume  of  an  able  article  by  Dr.  Beyer  published  in 
the  American  Journal  of  American  Sciences,  1886.  Kairin,  thallin,  and 
hydrochinon  added  to  blood  changes  its  color,  making  it  darker  than 
natural;  thallin  to  dark-brown  chocolate,  hydrochinon  to  cherry  red, 
resorcin  makes  the  color  brighter  red.  These  substances  produce  the 
same  change  when  injected  subcutaneously.  Antip3'rine  leaves  the  color 
of  the  blood  unchanged.  Kairin,  hydrochinon,  and  antipyrine  hasten 
coagulation.  Kairin,  thallin,  and  perhaps  hydrochinon,  are  destructive 
to  the  hemoglobin  All  these  substances  arrest  amceboid  movements. 
Kairin  dilates  the  capillaries  and  veins  much  in  excess  of  the  arteries;  it 
greatly  weakens  the  heart,  acting  directly  on  the  muscle.  It  reduces 
temperature  by  increasing  loss  through  radiation  and  by  diminishing 
heat  production  through  its  action  on  the  corpuscles.  Thallin  is  strik- 
ingly like  kairin,  but  thallin  has  a  much  less  injurious  effect  upon  the 
ventricle.  Thallin,  like  kairin,  reduces  temperature  by  lessening  heat 
production  and  increasing  loss  through  radiation. 

Kesorcin  dilates  capillaries  and  veins,  and  so  reduces  temperature  by 
increasing  radiation.  Like  kairin  and  thallin,  it  has  a  chief  affinity  for 
the  venous  side  of  the  heart.  It  paralyzes  the  auricles  in  doses  that  on 
the  contrary  rather  stimulate  the  ventricles.  Cappola  concludes  that 
antipyrine  lowers  body  temperature  by  increasing  radiation  and  not  by 
lessening  production  of  heat  or  depressing  the  heart,  for  it  increases  the 
strength  of  the  heart's  contractions  and  does  not  lower  blood  pressure. 
The  vascular  dilatation  does  not  depend  on  depression  of  the  vaso-motor 
centre,  but  is  peripheral,  as  it  occurs  in  tissues  separated  from  the  central 
nervous  system.  Beyer  concludes  that  it  cools  by  increasing  loss  of  heat, 
by  dilating  the  cutaneous  vessels.  It  is  tonic  to  the  heart  and  slightly 
heightens  blood  pressure.  It  has  no  injurious  effect  on  the  blood.  As 
regards  their  action  on  the  heart  these  various  substances  act  as  follows : 
kairin  and  thallin  paralyze  the  ventricles;  hydrochinon  and  resorcin 
weaken  the  ventricles  less,  but  all  greatly  weaken  the  auricles  and  lower 
the  tone  of  the  vessels,  and  hence  depress  by  the  blood  accumulating  in 
the  veins.  The  animal  bleeds  into  its  own  veins.  Antipyrine,  on  the 
other  hand,  strengthens  both  ventricles  and  auricles. 


PHENACETIN. 


An"  acetyl  compound  of  phenetidin,  allied  to  antifebrin,  is  the  last 
antipyretic.  It  is  but  little  soluble  in  water  or  glycerine.  It  has  been 
highly  praised.  My  experience  regarding  it  is  at  present  very  limited, 
and,  I  am  sorry  to  say,  is  not  favorable.  It  is  given  in  eight  to  twelve- 
grain  doses  every  four  or  six  hours. 


456  PAREIKxV    BliAVA. 


QUASSIA. 

Quassia  is  poisonous  to  some  of  the  lower  creatures,  as  flies  and  other 
insects. 

It  is  a  bitter  tonic.     It  has  been  used  in  intermittent  fever. 

Infusion  of  quassia  is  a  very  useful  injection  in  ascarides;  it  is  also 
efficacious  when  administered  by  the  mouth. 


CHAMOMILE. 


These  flowers  contain  both  a  volatile  oil  and  a  bitter  substance,  and 
thus,  to  some  extent,  combine  the  properties  of  bitters  with  those  of 
ethereal  oils. 

In  a  case  of  accidental  poisoning  by  chamomile  the  symptoms  were 
diarrhoea  of  white  putty  like  stools,  coated  tongue,  intense  headache, 
with  a  sensation  of  pressure  within  the  cranium. 

Chamomile  is  not  often  used  as  a  tonic.  An  infusion  is  sometimes 
employed  to  assist  the  action  of  emetics. 

In  the  ordinary  summer  diarrhoea  of  children,  often  occurring  during 
teething,  characterized  by  green,  many-colored,  and  slimy  stools,  the  in- 
fusion in  doses  of  half  a  drachm  or  a  drachm  often  proves  very  useful, 
especially  when  given  at  the  commencement.  This  medicine  is  likewise 
efficient  in  other  kinds  of  summer  diarrhoea.  It  also  subdues  restlessness 
and  peevishness.  A  mixture  is  easily  prepared  by  steeping  four  to  six 
heads  of  chamomile  flowers  in  a  teacupful  of  boiling  water  for  an  hour, 
and  then  giving  a  teaspoonful  hourly. 

It  has  been  used  in  intermittent  fever,  in  neuralgia  of  the  fifth  nerve, 
and  is  a  popular  remedy  for  "  sick  headache." 


PAEEIKA  BRAVA 


contains  an  alkaloid,  buxine,  said  to  be  identical  with  berberine.  It 
is  chiefly  employed  in  chronic  catarrh  of  the  bladder,  and  is  in  many 
cases  a  most  valuable  remedy,  checking  bleeding,  and  more  gradually 
muco-purulent  discharge.  It  often  ju'omptly  arrests  bleeding  from  the 
bladder,  though,  strange  to  say,  it  has  no  control  over  bleeding  from 
other  organs.  It  is  also  a  bitter  tonic,  and  often  increases  the  appetite. 
It  must  be  given  in  considerable  doses,  as  a  drachm  and  a  half  to  two 
drachms  or  more  of  the  liquid  extract  three  or  four  times  a  day. 

I  have  treated  patients  who  took  this  remedy  with  intermissions  for 
several  years,  in  whom  its  suspension  was  immediately  followed  by  a 
return  of  bleeding  and  considerable  increase  of  muco-pus  in  the  urine. 


ALOES  457 


ELATERIUM. 

This  drug  has  a  very  bitter  taste,  and  excites  free  secretion  of  saliva. 

It  is  a  powerful  drastic  hydragogue  cathartic.  Its  activity  is  due  to 
elaterin,  a  chemically  indifferent  substance  like  the  resins,  and  incapable 
of  forming  salts  with  either  acids  or  bases.  It  often  produces  colic,  and 
not  unfrequently  vomiting. 

In  large  doses  it  may  excite  inflammation  of  the  stomach  and  intes- 
tines, and  even  of  the  peritoneum.  It  is  given  as  a  purgative,  especially 
in  dropsies.  By  carrying  off  a  large  quantity  of  Avater  the  dropsy  some- 
times reduces;  it  is  thus  used  both  in  ascites  and  m  the  dropsy  from  kid- 
ney or  heart  disease.  It  must  be  borne  in  mind  that  free  purging  is  very 
exhausting,  and  that  elaterium  very  often  disorders  the  stomach  and  spoils 
the  appetite.     It  is  a  medicine  to  be  given  with  caution. 

Dr.  Hyde  Salter  strongly  recommends  purgatives  in  dropsy  depending 
on  aortic,  obstructive,  or  regurgitant  diseases.  He  says,  that  although 
we  cannot  alter  the  heart,  we  can  lessen  the  quantity  of  blood  it  has  to 
propel,  and  thus  diminish  the  congestion  on  which  the  dropsy  depends. 
He  employs  elaterium,  and  advises  a  small  dose  at  first,  say  one-sixth  of  a 
grain,  to  be  given  alternate  mornings  at  about  5  a.m.,  so  that  the  purga- 
tion usually  ceases  by  ten  or  eleven.  This  treatment,  he  says,  quiets  the 
heart,  relieves  the  dyspnoea,  lessens  the  pulmonary  congestion,  and  thus 
diminishes  the  hydrothorax. 


COLOCYNTH. 


This  drug  has  an  intensely  bitter  taste,  and  occasions  an  abundant 
secretion  of  saliva. 

It  produces  diarrhoea,  colic,  and  sometimes  vomiting.  The  diarrhoea 
is  watery,  and,  after  large  doses,  serous,  mucous,  and  bloody.  In  large 
doses  it  may  excite  gastro-enteritis  and  peritonitis. 

It  is  chiefly  used  as  a  purgative,  but  almost  always  in  combination  with 
other  substances.  In  obstinate  constipation  it  is  a  good  plan  to  give  a 
few  drops  of  the  Prussian  tincture  several  times  a  day.  Kohrig,  from  his 
experiments  with  fasting  animals,  is  led  to  place  colocynth  high  among 
cholagogues.  It  makes  the  bile  more  watery,  but  also  increases  the  solid 
constituents.     It  powerfully  stimulates  the  intestinal  glands. 

It  has  been  used  as  a  drastic  cathartic  in  dropsies,  and,  like  most  other 
powerful  purgatives,  it  has  been  used  for  worms,  although  it  has  no  direct 
poisonous  influence  on  them,  but  merely  expels  them  mechanically. 
Purgatives,  therefore,  are  not  good  anthelmintics. 


ALOES. 

Aloes  has  been  used  as  a  slight  stimulant  to  wounds,  and  when  thus 
employed  it  often  purges.  "  Dr.  Gerhard,  of  Philadelphia,  found  it  the 
medicine  best  adapted  for  endermic  uses,  as  its  application  does  not  irri- 


458 


ALOES. 


tate  a  blistered  surface  very  powerfully.  Ten  grains  of  aloes  thus 
employed  produced  five  or  six  stools,  which  were  generally  accompanied  by 
griping.  Infants  are  purged  by  the  milk  of  nurses  who  have  taken  aloes." 
— Stillc. 

Aloes  is  reputed  to  be  a  tonic,  and  to  increase  the  secretion  of  bile. 

Dr.  Rutherford  confirms  Rohrig's  statement,  that  Avhen  introduced  into 
the  duodenum  of  a  fasting  dog,  aloes  greatly  increases  all  the  biliary  con- 
stituents, though  it  purges  but  slightly. 

It  is  chiefly  employed  as  a  purgative.  It  acts  mainly  on  the  large 
intestine  and  rectum.  Its  action  is  slow,  and  six,  twelve,  or  even  twenty- 
four  hours  may  elapse  before  it  operates.  It  produces  bulky  motions,\i 
little  softened,  but  not  watery.  It  evidently  acts  but  little  on  the  mucous 
membrane  of  the  intestines,  and  it  is  merely  a  fa?cal  evacuant.  It  often 
occasions  slight  griping,  and  sometimes  tenesmus.  As  its  action  is  tardy, 
it  is  injudicious  to  combine  it  with  more  speedy  purgatives.  It  is  well 
suited  for  cases  of  chronic  constipation;  for  its  activity  is  not  lessened  by 
habitual  use,  and  it  is  even  said  that  the  dose  may  be  gradually  decreased. 
Sulphate  of  iron  is  said  to  heighten  its  action. 

When  both  a  tonic  and  a  purgative  are  required,  aloes,  like  senna,  may 
be  usefully  mixed  with  some  bitter,  as  gentian.  Purgatives,  it  is  said,  act 
in  smaller  quantities  when  combined  with  tonics. 

Aloes,  in  a  variety  of  combinations,  is  in  common  use  as  a  laxative  in 
habitual  dyspepsia,  with  constipation.  The  compound  decoction  of  aloes, 
formerly  called  baume  de  vie,  is  a  serviceable  after-dinner  laxative.  The 
basis  of  many  diniier  pills  is  one  grain  of  watery  extract  cf  aloes.  A  din- 
ner pill  containing  one  grain  of  watery  extract  of  aloes,  combined  either 
with  extract  of  nux  vomica,  extract  of  gentian,  or  extract  of  cinchona,  is 
very  useful. ' 

In  habitual  constipation  aloes  is  the  best  and  most  commonly  employed 
purgative.  Dr.  Spender,  of  Bath,  extols  the  following  pill,  taken  at  first 
three  times,  then  twice,  and  afterwards  once  a  day — one  grain  of  watery 
extract  of  aloes,  and  two  grains  of  sulphate  of  iron.  This  pill  takes  some 
days  to  act.  Aloes  has  been  accused  of  producing  piles,  and  in  full  or 
over-doses  will,  no  doubt,  aggravate  this  disease;  but  most  authorities  are 
inclined  to  attribute  piles  to  the  constipation  aloes  is  employed  to  remove, 
and  not  to  the  aloes  itself.  Indeed,  I  am  convinced  that  in  many  cases 
moderate  doses  of  aloes,  just  sufficient  to  gently  relieve  the  bowels,  are 
highly  useful  in  jiiles. 

Aloine,  injected  hypodermically,  purges  in  a  few  hours.  It  should  be 
dissolved  in  twenty-five  parts  of  water. 

By  its  action  on  the  rectum  aloes  affects  sympathetically  the  neighbor- 
ing pelvic  organs,  as  the  uterus;  and  given  at,  and  just  before,  the  men- 
strual period,  is  useful  in  many  cases  of  amenorrhcea  and  deficient 
menstruation.  Wc  cannot  here  refrain  from  citing  the  admirable  remarks 
of  Dr.  Graves  on  amenorrhcea  and  its  treatment.  ''  The  periodicity  of 
this  function,"'  he  says,  "can  still  be  traced,  even  in  cases  where  suppres- 
sion has  continued  for  a  great  length  of  time,  by  means  of  the  menstrual 
molimina  (pains  in  the  loins,  thighs,  and  hypogastric  region,  flushing, 
colicky  pains  of  the  abdomen,  general  feeling  of  malaise),  which  occur  at 
stated  intervals.     In  endeavoring  to  bring  on  the  discharge,  therefore,  we 

'  Guaiacum  is  useful  in  obstinate  habitual  constipation;  and  guaiacum  mixture  will 
often  relieve  the  bowels  when  powerful  purgatives  tall. 


ALOES.  459 

must  be  guided  as  to  the  time  the  attempt  should  be  made^  by  an  observ- 
ance of  the  period  at  which  these  molimina  occur.  For  a  few  days  before 
that  time  our  efforts  to  produce  a  determination  of  blood  to  the  uterus  may 
be  judiciously  employed,  and  if  they  fail  the  attempt  should  be  abandoned 
until  a  few  days  before  the  next  menstrual  period.  Of  course  I  here  speak 
of  the  general  constitutional  treatment,  for  this  must  be  constantly  per- 
severed in,  one  of  the  chief  means  of  bringing  back  tliis  evacuation  being 
the  restoration  of  health  to  the  natural  standard.  In  some  this  is  to  be 
effected  by  a  tonic,  and  in  others  by  an  opposite  mode  of  treatment. 

" AYhat  I  wish  to  impress  on  your  minds  is,  that  all  those  reme- 
dies, as  pediluvia,  scupiiig  of  the  genitals,  leeches  to  the  inside  of  the 
thighs  near  the  labia,  aloes,  and  other  stimulating  purgatives,  etc.,  should 
be  only  used  at  the  times  already  spoken  of.  To  use  them  at  any  other 
period,  either  after  the  molimina  have  disappeared  or  during  the  intervals 
between  them,  tends  in  most  cases  still  further  to  derange  nature,  by 
determining  to  the  uterus  at  an  unseasonable  time,  when  there  is  no  nat- 
ural tendency  to  that  organ.  Under  such  circumstances  the  very  same 
means  will  frequently  fail,  and  prove  injurious,  which,  applied  so  as  to 
coincide  with  the  time  of  the  natural  effort,  would  have  been  successful. 
To  illustrate  these  principles  by  an  example: — We  are  consulted  in  the 
case  of  a  young  woman  affected  with  various  hysterical  symptoms  for  sev- 
eral months,  and  during  that  period  more  than  usually  subject  to  headache, 
languor,  loss  of  spirits,  diminution  of  appetite  and  irregularity,  and  usu- 
ally constipation  of  bowels;  she  is  pale,  and  complains  of  various  pains  and 
uneasy  sensations,  and  has  not  menstruated  since  the  accession  of  these 
symptoms.  Here  it  is  evident  that  the  constitutional  treatment  must  be 
strengthening  and  tonic.  The  practitioner  will  therefore  recommend  reg- 
ular hours,  much  passive  exercise  in  the  open  air,  a  nutritious  diet,  and 
afterwards  cold  shower-baths;  he  will  regulate  the  bowels,  and  afterwards 
prescribe  a  course  of  tonic  medicines,  chalybeates,  preparations  of  bark, 
strychnia,  etc.,  he  will  likewise  inquire  carefully  Avhen  the  last  period 
happened,  and  Avhen  and  how  often  since  that  occurrence  menstrual 
molimina  were  observed.  He  thus  ascertains  when  they  should  again 
recur,  and  contents  himself  with  enforcing  the  constitutional  treatment 
until  about  six  days  before  the  calculated  time.  Then  he  lays  aside  the 
other  medicines,  and  has  recourse  to  those  means  which  determine  to  the 
uterus.  Two  leeches  are  applied  to  the  inside  of  the  thigh,  near  the  labium, 
every  second  night,  until  they  have  been  three  times  applied.  The  bleeding 
is  encouraged  by  stuping.  On  the  intermediate  days  the  bowels  must  be 
actively  moved  by  aloetic  pills,  and  for  three  nights  before  and  after  the  mo- 
limina, liot  pediluvia.  rendered  stimulating  by  mustard  seed,  may  be  xised. 
During  the  same  time  also  friction,  Avith  stimulating  liniments,  should 
be  applied  to  the  feet  and  legs  every  morning,  and  oil  of  turpentine,  or 
tincture  of  cantharides  may  be  exhibited  internally,  while  the  necessity  of 
more  active  exercise  is  inculcated.  If  these  means  fail,  they  must  for  a 
moment  be  laid  aside,  and  the  constitutional  treatment  must  be  again 
resumed  until  the  same  number  of  days  before  the  next  period,  when  the 
list  of  remedies  above  spoken  of  must  be  again  tried,  and  in  few  cases 
indeed  shall  we  find  them  to  fail." — Graves'  Clinical  Lectures. 


460  JALAP SCAMMONY. 


SQUILL 

contains  a  glucoside,  scillitoxin.  Squill  has  a  bitter  taste.  It  acts  pow- 
erfully on  the  stomach  and  intestines  in  full  doses,  exciting  great  nausea 
and  vomiting,  with  frequent  watery  and  even  bloody  diarrhcea.  Similar 
symptoms  are  likewise  produced  when  the  drug  is  injected  into  the 
cellular  tissue  or  jjeritoneal  cavity.     Squill  acts  like  digitalis. 

Squill  is  never  used  as  an  emetic  or  purgative,  but  almost  exclusively 
as  an  expectorant  in  bronchitis,  and  is  often  given  in  heart  cases  in  con- 
junction with  digitalis,  especially  when,  in  addition  to  cardiac  disease, 
there  is  bronchitis  with  much  mucous  secretion. 

It  is  a  diuretic  in  heart  disease.  It  is  recommended  in  all  forms  of 
dropsy. 


JALAP.     SCAMMONY. 

BuCHHEiM  asserts  that  these  two  substances  are  rendered  purgative 
only  by  combining  with  the  bile;  unmixed  Avith  this  secretion  they  are 
inert.  They  are  easily  soluble  in  the  Ijile,  and  probably  undergo  decom- 
position, but  the  products  are  unknown.  Taurin  and  glycoll  exert  no 
influence  on  their  efficacy,  but  it  is  otherwise  with  tauro-cholate  and  glyco- 
cholate  of  soda;  hence  Buchheim  conciludes  that  the  activity  of  these 
drugs  is  determined  by  the  soda  of  the  bile.  They  excite  diarrhoea  of 
watery  motions,  with  some  colic  and  occasional  vomiting,  and  their  use  is 
often  followed  by  much  constipation. 

These  medicines  are  used  as  purgatives  in  obstinate  constipation,  and 
jalap,  in  combination  with  other  substances,  is  employed  in  dropsies. 
Scammony  is  frequently  used  with  much  advantage  to  destroy  the  small 
thread-worms  infesting  the  rectum. 

Kohrig  and  Rutherford  coi:iclude  from  their  experiments  on  fasting 
dogs  that  jalap  is  a  powerful  cholagogue.  It  increases  the  watery  and 
solid  constituents  of  the  bile,  and  powerfully  stimulates  the  intestinal 
glands. 

Dr.  Eutherford  finds  that  scammony  given  to  fasting  dogs  is  a  feeble 
cholagogue,  even  when  it  purges. 

Bleeding  has  recently  been  employed  with  great  success  in  engorge- 
ment of  the  right  side  of  the  heart  from  emphysema  and  bronchitis,  mitral 
obstructive  or  regurgitant  disease.  Now,  for  some  years  I  have  employed 
purgatives  in  these  cases  with  considerable  benefit,  to  produce  three  or 
four  watery  motions,  and  I  venture  to  say  that  this  treatment,  first 
employed  by  Dr.  Graves,  saves  many  lives. 

Like  bleeding,  free  purging  unloads  the  distended,  and  therefore  weak- 
ened right  heart,  and  it  moreover  ])ro(luces  a  very  favorable  change  in  the 
character  of  the  expectoration,  rendering  its  expulsion  easier.  The  follow- 
ing case,  one  among  many  similarly  benefited  by  free  purging,  will  illlus- 
trate  the  advantage  of  this  phin. 

A  woman  about  forty  years  of  age,  suffering  from  emphysema,  was 
seized  with  severe  bronchitis.  She  had  been  dangerously  ill  about  a  fort- 
nigiit:  her  skin  was  of  a  deep  leaden  tint;  her  eyes  were  prominent,  con- 


RHUBARB.  461 

gested,  and  suffused;  her  jugular  veins  were  greatly  distended;  the  surface 
of  her  body  Avas  covered  with  a  cold  clammy  perspiration,  profuse  on  her 
face;  her  extremities  were  deadly  cold;  her  temperature  varied  between 
97°and  98°  Fah,  She  suffered  from  slight  delirium  both  night  and  day. 
Her  breathing  was  hurried,  and  her  chest  expanded  only  slightly;  expec- 
toration was  abundant,  viscid,  airless,  and  purulent;  pulse  large,  but  very 
compressible,  varied  from  96  to  100  beats  in  the  minute.  The  respiratory 
sounds  were  obscured  by  an  abundance  of  mucous  rhonchus,  and  physical 
examination  showed  that  the  right  side  of  her  heart  was  greatly  distended. 
Her  urine  contained  a  trace  of  albumen;  her  legs  were  not  oedematous. 
So  dangerously  ill  was  she  that  death  appeared  imminent.  After  free 
purgation  with  jalap  and  bitartrate  of  potash,  in  a  few  hours  the  jugular 
veins  became  much  less  distended,  and  next  day  they  were  of  natural 
size;  while  the  deep  leaden  tint  of  her  skin  had  given  place  to  a  diffused 
bright  red  color,  often  witnessed  in  cases  treated  in  this  way;  this  color 
being  probably  due  to  the  capillaries — previously  distended  by  the  obstruc- 
ted circulation,  till,  being  weakened,  they  lose  their  power  lo  contract — 
becoming  filled  with  arterial  instead  of  venous  blood.  This  bright  red  color 
was  most  marked  over  the  face  and  hands;  her  skin  became  warm,  though 
she  continued  to  perspire  freely,  and  her  hands  easily  grew  cold  on  expo- 
sure. She  expressed  herself  much  relieved.  In  twenty-four  hours  the  ex- 
pectoration became  slightly  aerated,  this  change  being  much  more  marked 
on  the  following  day,  when  the  expectoration  was  observed  to  be  less 
purulent,  and  to  contain  much  mucus.  On  the  third  day  the  expectora- 
tion was  frothy,  and  consisted  chiefly  of  mucus;  coincidently  with  this 
improvement  in  the  sputa,  her  chest  expanded  more  perfectly,  and  the 
rhonclius  diminished.  From  this  time  she  steadily  improved,  and  was 
discharged  cured. 

The  engorgement  of  the  right  heart,  with  general  venous  congestion, 
is  no  doubt  ix\)t  to  return,  when  it  becomes  again  necessary  to  purge; 
indeed,  several  purgings  may  be  required.  It  will  rarely  happen,  I 
believe,  that  the  venous  congestion  cannot  be  removed  temporarily  by  this 
treatment. 

The  change  in  the  expectoration  sometimes  takes  place  more  slowly 
than  in  the  foregoing  case,  a  week  elapsing  before  it  becomes  frothy,  and 
composed  of  mucus.  Any  tendency  of  the  expectoration  to  assume  its  old 
characters  may  be  prevented  by  a  repetition  of  the  aperient. 

Sometimes  these  patients  complain  of  very  severe  dull  headache,  or  of 
dull  oppressive  pain  at  the  epigastrium:  bleeding  or  purging  relieve  both 
symptoms,  bleeding  giving  instant  ease. 

In  persistent  tricuspid  regurgitation  from  permanent  distention  of  the 
right  side  of  the  heart,  induced  by  repeated  attacks  of  bronchitis,  pur- 
gatives will  probably  be  of  no  iise  except  when  an  attack  of  bronchitis, 
adding  to  the  obstruction  of  the  pulmonary  circulation,  increases  the 
dilatation. 


EHUBAEB. 


Rhubarb  is  a  purgative,  and  is  likewise  a  tonic.  After  purging 
it  constipates,  on  which  account  it  is  often  used  in  the  early  stages  of 
diarrhoea,  to  get  rid  of  any  irritating  matter  from  the  intestines,  and  after 


462        SENNA CASCARA  SAGRADA EUONYMUS. 

their  expulsion,  to  check  the  diurrlioea.  It  is  a  very  useful  purgative  for 
children,  especially  when  mixed  with  two  or  three  times  its  weight  of  bicar- 
bonate of  soda. 

Eohrig  finds  tliat  rhul^arb,  given  to  fasting  dogs,  greatly  increases  all 
the  constituents  of  the  bile,  though  the  rhubarb  either  failed  to  purge,  or 
purged  very  slighty;  and  Eutherford.  verifies  this  observation. 

L)r.  Stillc,  on  the  authority  of  Dr.  S.  Jackson  (U.S.),  Avhose  testi- 
mony he  indorses,  speaks  of  rhubarb  as  a. remedy  of  surprising  efficacy  in 
j)iles,  when  laxatives  are  needed.  He  directs  a  piece  Aveighing  about  ten 
grains  to  be  chewed,  or  rather  slowly  dissolved  in  the  mouth  nightly,  or 
less  frequently  according  to  the  degree  of  constipation,  estimating  that  rhu- 
barb taken  in  this  fashion  is  five-fold  more  efficacious  than  the  powder.  He 
also  recommends  it  in  the  costiveness  and  hiemorrhoidal  swellings  inci- 
dent to  pregnancy.     (Stillc's  Tlierapeuticx.) 

Ehubarb  generally  colors  the  urine  reddish  yellow,  which,  on  the 
addition  of  ammonia  and  other  alkalies,  changes  into  a  purple  red.  It  col- 
ors also  the  sweat,  the  serum  of  the  blood,  and  the  milk;  and  it  makes 
the  milk  bitter  and  purgative. 

It  may  be  usefully  blended  with  some  tonic. 


SENNA. 

Senna  is  an  active  purgative,  promoting  both  secretion  and  peristaltic 
action.  It  often  produces  nausea  and  griping.  It  may  be  usefully  com- 
bined with  a  bitter  tonic,  as  in  the  mistura  gentianre  composita?  of  former 
pharmacopoeias.  This  mixture  is  very  useful  in  dyspepsia  with  constipa- 
tion, and  contains  an  ounce  of  compound  infusion  of  gentian  to  half  an 
ounce  of  compound  infusion  of  senna.  Senna  renders  a  mother's  milk 
jiurgative,  and  may  produce  colic  in  the  child. 

Eohrig  and  Eutherford  find  that  in  fasting  dogs  senna  slightly  in- 
creases the  secretion  of  the  bile. 


CASCAEA  SAGEADA. 

One  of  the  buckthorn  family,  derived  from  Ehamnus  Purshiana. 
Like  the  other  buckthorns,  it  is  purgative,  but  less  drastic  than  rhamnus 
catharticus,  and  more  active  than  rliamnus  frangula.  It  acts  promptly 
and  without  griping,  and  is  now  largely  used  with  great  advantage  as  a 
laxative,  especially  in  habitual  constipation.  It  is  said  to  cure  functional 
habitual  constipation.  I  have  not  yet  met  a  case  of  habitual  constipation 
cured  solely  by  the  use  of  this  drug.  It  may  be  given  as  the  liquid  ex- 
tract in  ten  to  fifteen-minim  doses  tAvice  or  thrice  a  day,  or  in  the  form 
of  extract  in  doses  of  two  to  four  grains  in  a  pill  at  bed-time. 


EUONYMUS 


is  used  in  the  form  of  extract  in  about  two-grain  doses,  as  purgative  and 
stimulant  to  the  liver,  and  is  said  to  increase  the  secretion  of  bile. 
Large  doses  cause  much  intestinal  irritation.     A  short  time  ago  it  Avas 


ANTIIEL.AIINTICS.  463 

employed  much  more  than  at  present,  in  place  of  mercury  preparations  or 
podophyllin. 

Though  much  less  used  now,  it  is  no  doubt  a  useful  drug,  hut  I  think 
it  inferior  in  most  cases  to  its  rivals,  mercurial  preparations  or  podophyllin. 


SENEGA. 


Senega  promotes  the  secretion  of  the  bronchial  mucous  membrane, 
and  probably  that  of  the  other  mucous  membranes.  It  produces  a  burn- 
ing, itching  sensation  in  the  mouth  and  throat. 

It  is  used  in  chronic  bronchitis,  especially  in  the  case  of  aged  people, 
in  whom  this  disease  is  usually  complicated  Avith  emphysema.  Some  give 
it  in  croup  and  whooping-cough.  It  is  also  reputed  to  be  diuretic,  and  is 
used  when  the  deficiency  of  urine  is  due  to  kidney  disease.  "  Infusion  of 
senega  (four  to  six  drachms  infused  in  six  to  twelve  ounces  of  water,  and 
taken  during  the  day)  produced  no  effect  on  the  urine  in  Boker's  experi- 
ments, conducted  on  himself  and  on  a  pregnant  woman."  (Parkes  6^^i 
Urine. ) 


Anthelmintics — 

FILIX   MAS.  AEECA  NUT. 

KOUSSO.  BAKK  OF   THE   POME- 
KAMELA.  GRANATE   ROOT. 

SANTONIN.  POWDERED  TIN. 

TURPENTINE.  MUCUNA,    etc. 

The  intestines  are  infested  by  worms  of  various  kinds.  The  common 
kinds  are  the  flat  worms  (Taenia  solium  and  Bothriocephalus  latus),  round 
wornis  (Ascaria  lumbricoides),  and  thread-worms  (Ascaria  vermicularis). 

Worms  may  be  treated  in  three  ways.  Drugs,  as  powdered  tin  and 
mucuna,  may  be  employed  to  kill  the  worm  by  their  mechanical  action, 
or  powerful  purgatives  may  be  used  simply  to  expel  the  worm,  as  jalap, 
scammony,  etc. ;  or  true  vermicides,  having  very  little  effect  on  the  tissues 
of  the  human  body,  to  poison  and  kill  the  Avorm.  With  the  exception  of 
powdered  tin  and  mucuna,  all  the  medicines  comprised  in  the  foregoing 
group  are  vermicides.  It  must,  hoAvever,  be  borne  in  mind  that  all  are 
not  equally  efficacious  against  every  kind  of  Avorm,  for  some  are  poisonous 
to  one  kind,  and  harmless  to  another.  Success,  in  fact,  depends  not  only 
on  giving  the  fitting  drug,  but  giving  it  in  the  right  Avay.  These  inedi- 
cines  should  reach  the  Avorms  in  as  concentrated  a  state  as  possible;  but  if 
the  stomach  and  intestines  are  filled  Avith  food,  the  poison,  being  thus 
diluted,  may  fail  to  destroy  the  Avorms.  It  is  proper,  therefore,  to  giA^e 
overnight  a  ])urgative,  and  to  direct  the  patient  to  take  a  very  light  tea 
and  no  supper,  and  oii  the  folloAving  morning,  after  the  purgative  action, 
to  give  the  anthelmintic. 

FiLix  Mas  is  employed  for  tape- worm.  Kuchenmeister  asserts  that  it 
is  more  poisonous  to  the  bothriocephalus  than  to  the  ta?nia.  The  patient 
should  eat  a  very  light  tea,  no  supper,  and  just  before  bedtime  SAvalloAV  a 


464:  ANTHELMINTICS. 

dose  of  castor-oil,,  a  purgative  to  be  preferred  to  others  on  account  of  its 
speedy  action.  On  tlie  following  morning,  about  six  or  seven  o'clock, 
when  the  oil  will  generally  have  acted,  give  the  liquid  extract  of  male 
fern  in  a  dose  varying  from  ten  drops  to  a  drachm,  according  to  age.  The 
patient  is  then  to  abstain  from  food  till  the  bowels  have  been  freely 
relieved,  when  in  most  cases  the  worm  will  be  expelled.  Some  recom- 
mend a  brisk  jiurge  to  follow  the  anthelmintic,  but  this  is  seldom  neces- 
sarv,  as  the  foregoing  simple  plan  rarely  fails  to  dislodge  the  worm. 
Too  large  a  dose  of  the  male  fern  may  cause  nausea,  sickness,  and  even 
colic,  effects  seldom  witnessed  with  a  moderate  dose.  The  liquid  extract 
of  male  fern  is  slightly  purgative,  and  for  this  reason  it  is  not  always  nec- 
essary to  administer  a  purgative  after  it.  The  worm  should  be  carefully 
examined  in  order  to  ascertain  if  the  head  has  been  expelled;  in  that  case 
there  is  no  fear  of  the  re-growth  of  the  worm.  It  has,  however,  been 
ascertained,  that  if  only  the  head  and  a  small  piece  of  the  neck  are  left 
the  worm  will  die,  so  that  if  the  head  cannot  be  discovered,  it  must  not  be 
concluded  that  the  patient  is  not  permanently  freed  of  the  worm.  If  any 
piece  is  found  wdiich  tapers  to  a  fine  point,  even  if  the  head  is  not 
attached,  it  may  reasonably  be  hoped  that  the  worm  is  destroyed.  A 
good  plan  to  obtain  for  examination  all  the  expelled  worm  is  to  shake  up 
the  motions,  already  Avatery  and  loose  from  the  purgative,  with  some 
Avater,  and  to  filter  the  whole  through  a  piece  of  coarse  muslin,  by  which 
means  the  head,  even  if  separated  from  the  trunk,  may  be  detected  and 
examined. 

Male  fern  is  generally  considered  the  fittest  treatment  for  the  flat 
worm. 

Kousso  is  used  for  tape-worm  of  all  kinds,  and  appears  to  be  very  suc- 
cessful, although  not  much  employed  in  this  country.  In  Al:)yssinia,  where 
tape-worm  is  extremely  common,  kousso  has  been  in  use  upwards  of  two 
centuries.  The  dose  is  half  an  ounce  of  the  floAvers  suspended  in  Avater, 
and  taken  after  a  short  fast,  as  in  the  previous  case.  Kuchenmeister 
asserts  that  kousso  expels  the  Avorm  sloAvly,  and  in  pieces,  and  that  it  rarely 
expels  the  head.  It  may  cause  slight  nausea  and  even  vomiting.  Its 
action  on  the  boAvels  being  very  slight  it  is  customary  to  folloAV  this  by  a 
mild  purgative. 

The  bark  of  the  root  of  punica  granatum  is  the  part  used.  It  is  em- 
ployed chiefly  in  India  for  tape-Avorm.  Xeligan  directs  the  maceration  of 
tAVO  ounces  of  briiised  bark,  of  fresh  root  if  possible,  for  twenty-four  hours 
in  tAVO  pints  of  water,  to  be  then  boiled  doAvn  to  half,  strained,  and  di- 
vided into  three  doses,  one  to  be  taken  -dt  half-hour  intervals.  Vomiting 
often  occurs,  Avhicli,  hoAvever,  should  not  prevent  the  giving  of  the  three 
doses.  This  treatment  should  be  occasionally  repeated  daily  for  four  or 
five  days.     ]\Iost  practitioners  find  the  dried  root  inert. 

LandricAV  and  Baumetz  find  the  alkaloid  of  pomegranate,  pelletierine, 
useful  for  tape-v\'orm.  Fifteen  to  tAventy  grains  of  the  tannate,  folIoAved 
in.  a  fcAv  hours  by  castor-oil,  sometimes  succeeds  when  other  remedies 
have  failed.  Feraud  completely  cured  7G  per  cent,  of  his  cases  with  this 
alkaloid. 

Saxtonix,  the  active  principle  of  Avorm  seed,  is  very  efficacious  for 
round  and  thread-Avorms,  but  it  is  inoperative  against  tape-Avorms.  In 
the  treatment  both  of  round  and  thread-Avornis,  tAvo  to  four  grains,  accord- 
mgto  age,  are  to  be  mixed  with  a  drachm  or  more  of  castor-oil,  and  taken 
early  in  the  morning  before  breakfast,  repeating  the  dose  tAVO  or  three 


ANTHELMLNTICS.  465 

mornings  successively.  Such  treatment  seldom  fails  to  bring  away  any 
round  or  thead-worms.  Santonin  has  been  used,  mixed  with  castor-oil,  as 
an  injection  into  the  rectum  for  thread-worms,  and  Kuchenmeister  found 
that  santonin  in  castor-oil,  mixed  with  albumen,  killed  ascarides  in  ten 
minutes,  while  without  the  oil  the  santonin  had  no  effect.  He,  therefore, 
recommends  it  to  bo  given  in  two  to  five-grain  doses  in  a  ounce  of  castor-oil. 
This  quantity  is  of  course  intended  for  adults.  Santonin  may  be  conven- 
iently given  in  syrup,  lozenge,  or  ginger-bread.  In  an  obstinate  case  some 
advise  the  administration  of  one  or  two  grains  twice  or  three  times  a  day; 
but  repeated  so  often  this  medicine  is  very  apt  to  occasion  sickness  and 
vomiting,  with  great  difficulty  in  holding  the  water,  so  that  children,  if 
overdosed  with  it,  are  apt  to  Avet  the  bed  at  night,  are  constrained  to  pass 
Avater  very  frequently,  and  are  even  unable  to  hold  it  night  or  day.  San- 
tonin colors  the  urine  orange,  which  changes  to  a  brilliant  scarlet  on  the 
addition  of  solution  of  ammonia.  It  is  curious  that  this  remedy  will  some- 
times stay  the  nocturnal  incontinence  of  children;  and  Avlien  the  incon- 
tinence is  not  dependent  on  the  presence  of  worms,  santonin  succeeds 
occasionally  Avhere  other  remedies,  including  even  belladonna,  fail.  It 
may  produce  headache,  and  sometimes  affects  smell  and  taste,  and  some- 
times it  makes  objects  appear  of  a  green  or  yellow  color.  Kose  finds  that 
santonin  always  produces  hyperemia  of  the  retina,  and  he  with  Dr.  Ogs- 
ton  believes  the  color  is  owing  to  its  influence  either  on  the  retina  or  brain, 
for  it  does  not  color  the  structures  of  the  eye.  Drs.  Ogston  and  Brown 
assert  that  santonin  produced  cataract  in  the  eyes  of  young  kittens,  but 
they  were  unable  to  induce  this  condition  in  adult  cats.  These  gentle- 
men recommend  santonin  in  certain  eye  diseases,  as  inflammatory  and 
atrophic  alterations  in  the  retina  and  optic  nerve  producing  deficient  sight. 

liaimondi  and  Bertiui  record  a  case  Avhere  an  ounce  of  santonin 
induced  vomiting,  giddiness,  prostration,  shivering,  lividity,  diflficult 
breathing,  followed  by  repeated  epileptiform  convulsions.  The  patient 
recovered. 

Mr.  Whitehead,  of  Manchester,  finds  santonin  useful  in  amenorrhoea. 
He  gives  a  ten-grain  dose  on  two  successive  nights  with  almost  uniform 
success,  especially  when  the  amenorrhoea  is  combined  with  chloro-ana?mia. 
Dr.  Armand  Routh  tried  santonin  in  twenty  cases  of  amenorrhoea,  giving 
ten  grains  on  two  successive  nights.  In  seventeen  it  failed.  He  thinks 
it  useless  in  amenorrhoea  with  chlorosis.  When  it  succeeds  it  starts  the 
discharge  without  pain. 

Santonm  may  be  conveniently  given  in  form  of  suppository  for  thread 
worms. 

Kamela  is  much  used  in  India  for  tape-worm.  It  may  be  given  in 
doses  from  GO  to  120  grains,  in  honey,  syrup,  or  glycerine.  It  purges 
briskly. 

Areca  nut  is  much  used  by  veterinarians  to  expel  tape-worms  from 
dogs,  and  may  be  employed  for  the  same  purpose  in  the  human  subject;  it 
sometimes  succeeds  when  other  remedies  fail.  Half  or  a  whole  nut  is  to 
be  powdered,  and  mixed  Avith  some  syrup,  and  sAvallowed. 

Neligan  commends  Turpentine  for  its  poisonous  effectiveness  OA'er 
both  tape  and  round  Avorms,  but  it  is  more  deadly  to  the  tape-Avorm.  It  is 
also  efficacious  used  as  an  injection  for  thread-AVorms.  Kucheimieister 
shows  that  it  destroys  tape-worm  in  an  hour. 

Of  all  medicines  to  be  sAvalloAved,  santonin  is,  as  Ave  have  said,  most 
effectual  against  thread- worms,  Avhich  infest  only  the  rectum.    Scammony, 


466  ANTHELMINTICS. 

too,  is  effectual  against  thread-worms.  A  variety  of  substances  adminis- 
tered by  injection  will  speedily  destroy  thread-worms.  Thus,  ateaspoonful 
of  common  salt  in  solution,  infusion  of  quassia,  or  a  drachm  of  sesqui- 
chloride  of  iron  in  a  pint  of  water  are  very  efficacious;  so  is  lime-water, 
solution  of  alum,  and,  in  fact,  any  substance  which  will  coagulate  the 
albumen  of  the  worms. 

In  the  treatment  of  worms  it  must  always  be  remembered  that  the 
mucous  membrane  is  generally  in  an  unhealthy  state,  secreting  much  te- 
nacious mucus,  which  forms  a  favoring  nidus  for  the  development  of 
worms;  for  worms  will  rarely  develop  in  a  healthy  state  of  the  digestive 
canal.  The  foregoing  modes  of  treatment  are  therefore  only  temporarily 
remedial,  and  after  the  expulsion  of  the  worms,  the  morbid  condition  of 
the  intestinal  mucous  membrane  must  be  treated.  This  condition  of  the 
intestines  generally  occurs  in  unhealthy  ansemic  children.  Cod-liver  oil 
and  iron  preparations  soon  restore  the  gastro-intestinal  canal  to  a  healthy 
condition. 

Oils,  as  is  well  known,  are  reputed  to  be  vermicides. 

If  the  foregoing  remedies  fail,  other  medicines  must  be  employed  to 
remove  the  catarrhal  state  of  the  mucous  membrane,  as  common  salt, 
chloride  of  ammonium,  and  salts  of  antimony.  Cold-sponging,  out-door 
exercise,  with  a  judicious  diet,  aid  the  improvement  of  the  general  health. 


DIETARY  FOR  INVALIDS. 


1,  Barley  Soup. 


One  pound  of  shin  of  beef,  four  ounces  of  pearl  barley,  one  potato,  salt  and  pepper 
to  taste,  one  quart  and  a  half  of  water. 

Put  all  the  ingredients  into  a  pan,  and  simmer  gently  for  four  hours.  Strain,  return 
the  barley,  and  heat  up  as  much  as  required. 

2.  Bkead  Soup. 

One  pound  of  bread,  two  ounces  of  butter,  one  qviart  of  stock. 
Boil  the  brea<l  with  the  butter  in  stock.     Beat  the  whole  with  a  spoon  or  fork,  and 
keep  it  boiling  till  the  bread  and  stock  are  thoroughly  mixed.     Strain,  season,  and  serve. 

3.  Tapioca  Soup. 

Two  ounces  and  a  half  of  tapioca,  one  quart  of  stock. 

Put  the  tapioca  into  cold  stock,  and  bring  it  gi-adually  to  the  boiling  point.  Simmer 
gently  till  tender,  and  serve. 

4.  Sardinian  Soup. 

Two  eggs,  a  quarter  of  a  pint  of  cream,  one  ounce  of  fresh  butter,  salt  and  pepper 
to  taste,  a  little  flour  to  thicken. 

Beat  the  eggs,  put  them  into  a  stewpan,  and  add  the  cream,  butter  and  seasoning, 
stir  in  as  much  flour  as  will  bring  it  to  the  consistency  of  dough,  make  it  into  balls  the 
size  and  shape  of  a  nut,  fry  in  butter,  and  put  them  into  a  basin  of  any  sort  of  soup  or 
broth,  to  which  they  make  a  verj'  nice  adtlition. 

5.  Restorative  Beef  Essence,  1. 

Take  one  pcnrnd  of  fresh  beef,  free  from  fat.  chop  it  up  fine,  and  pour  over  it  eight 
ounces  of  soft  water,  add  five  or  six  drops  of  hydrochloric  acid,  and  fifty  or  sixty 
grains  of  common  salt,  stir  it  well,  and  leave  it  for  three  hours  in  a  cool  place.  Then 
pass  the  fluid  through  a  hair  sieve,  pressing  the  meat  shghtly,  and  adding  gradually 
towards  the  end  of  the  straining  about  two  or  more  ounces  of  water.  The  liquid  thus 
obtained  is  of  a  red  color,  ]wssessing  the  taste  of  soup.  It  should  be  taken  cold,  a 
teacupfid  at  a  time.  If  preferred  warm,  it  must  not  be  put  on  the  fire,  but  heated  in 
a  covered  vessel  placed  in  hot  water. 

Should  it  be  undesirable  for  the  patient  to  take  the  acid,  this  soup  may  be  made  by 
merely  soaking  the  minced  beef  in  distilled  water. 

G.  Another  Beef  Essence,  2. 

Take  one  pound  of  gravy  beef,  free  from  fat  and  skin,  chop  it  up  very  fine,  add 
a  little  salt,  and  put  it  fnto  an  earthen  jar  with  a  lid,  fa.sten  up  the  edges  with  a  thick 
paste,  such  as  is  used  for  roasting  venison  in,  and  place  the  jar  in  the  oven  for  three  or 
four  hours.  Strain  through  a  coarse  sieve,  and  give  the  patient  two  or  three  tea- 
spoonfuls  at  a  time. 

7.  Beef  Essence,  3. 

Cut  up  in  small  pieces  one  pcnmd  of  lean  beef  from  the  sirloin  or  nunp,  and  place 
it  in  a  covered  saucepan,  with  half  a  pint  of  cold  water,  by  the  side  of  the  fire  for  four 
or  five  hours,  then  allow  it  to  sinuuer  gently  for  two  hours.     Skim  it  well,  and  serve. 


468  DIETARY    FOR    INVALIDS. 

8.  Beef  Tea. 

Two  pounds  of  beef  without  fat  or  bone,  half  a  breakfast-cup  of  cold  water,  place 
it  in  a  iar  in  a  saucepan  of  water.     Simmer  four  hours. 


9.  MuTTOx  Jelly. 


Six  shanks  of  mutton,  three  pints  of  water,  pepper  and  salt  to  taste,  half  a  pound 
of  lean  beef,  a  crust  of  bread  toasted  brown. 

Soak  the  shanks  in  water  several  hours,  and  scrub  them  well.  Put  the  shanks,  the 
beef  and  other  ingredients  into  a  saucepan  with  the  water,  and  let  them  simmer  very 
gently  for  tive  hours.  Strain  it,  and  when  cold  take  off  the  fat.  Warm  up  as  much 
as  is  wanted  at  a  time 

10.  Beef  Tea  with  Oatmeal. 

Mix  two  table-spoonfuls  of  oatmeal  very  smooth  with  two  spoonfuls  of  cold  water, 
then  add  a  pint  of  strong  ])oiling  beef  tea.  Boil  together  for  live  or  six  minutes,  stirring 
it  well  all  the  time.     Strain  it  through  a  sieve,  and  serve. 

11.  Baked  Soup. 

One  pound  of  lean  beef,  one  ounce  of  rice,  pepper  and  salt  to  taste,  one  pint  and  a 
half  of  water. 

Cut  up  the  meat  into  slices,  add  the  rice  and  seasoning,  place  all  in  a  jar  with  tlie 
water,  cover  it  closely,  and  bake  for  four  hours.  Pearl  barley  may  be  substituted  for 
rice  if  preferred. 

12.  Mutton  Broth. 

Two  or  three  pounds  of  neck  of  mutton,  two  pints  of  water,  pepper  and  salt,  half 
a  pound  of  potatoes,  or  some  pearl  ])arley. 

Put  the  mutton  into  a  stewpan,  pour  the  water  over  it,  pepper  and  salt.  When  it 
boils,  skim  carefully;  cover  the  pan,  and  let  it  simmer  gently  for  an  hour.  Strain  it, 
let  it  get  cold,  and  then  remove  all  the  fat.  When  required  for  use,  add  some  pearl 
barley  or  potatoes  in  the  following  manner: — Boil  the  potatoes,  mash  them  very  smoothly 
so  that  no  lumps  remain.  Put  the  potatoes  into  a  pan,  and  gradually  add  the  mutton 
broth,  stirring  it  till  it  is  well  mixed  and  smooth;  let  it  simmer  for  live  minutes,  and 
serve  with  fried  bread. 

13.  Soup. 

Take  three  or  four  pared  potatoes,  a  thick  slice  of  bread,  half  a  teacupful  of  pearl 
barley  or  rice,  a  little  salt  and  pepper,  two  quarts  of  beef  tea  or  mutton  broth.  Heat 
the  beef  tea  or  broth  in  a  pan,  and  when  quite  boiling  add  the  rest  of  the  ingredients, 
except  the  pepper  and  salt,  which  should  be  added  when  nearly  done;  cover  the  pan, 
and  let  it  boil  slowly  for  an  hour.     Serve  with  toasted  bread. 

14.    Rabbit  Soup. 

Soak  a  rabbit  in  warm  water,  and,  when  quite  clean  cut  it  in  pieces,  and  put  it  into 
a  stewpan  with  a  teacupful  of  veal  .stock  or  broth ;  simmer  .slowly  till  done  through, 
then  add  a  quart  of  Avater  and  boil  for  an  hour.  Then  take  out  "the  rabbit,  pick  the 
meat  from  the  bones,  covering  it  up  to  keep  it  white;  put  the  bones  back  into  the 
liquor,  and  simmer  for  two  hours,  skim,  strain,  and  let  it  cool.  Pound  uj)  the  meat  in 
a  mortar,  with  the  yolks  of  two  hard-boiled  eggs,  and  the  crumb  of  a  French  roll,  pre- 
viously soaked  in  niilk;  nd)  it  through  a  tammy,  and  gradually  add  the  strained  li(iuor, 
and  simmer  it  for  tifteen  minutes.  If  liked  thick,  mix' some  arrowroot  with  half  a  pint 
of  new  milk,  bring  it  to  the  l)()il,  mix  Avith  the  soup,  and  serve.  If  jireferred  thin, 
have  ready  some  pearl  barley,  and  vermicelli  boiled  in  milk,  and  add  to  the  soup, 
instead  of  "the  arroAvroot.     Serve  Avitli  little  squares  of  toast  or  fried  bread. 

15.  Calf's  Foot  Broth. 

One  calf's  foot,  three  pints  of  water,  one  small  lunxp  of  sugar,  the  yolk  of  one  Qgg. 

Stew  the  foot  in  Avater  very  gently,  till  the  liquor  is  reduced  to  half;   remove  the 

scum,  set  it  in  a  basin  till  quite  Void,  then  take  olT  every  particle  of  fat.     Warm  up 


DIETARY    FOR    IISTVALIDS.  4G9 

about  half  a  pint,  adding  the  sugar,  taking  it  off  the  tire  for  a  minute  or  two,  then  add 
the  beaten  yolk  of  the  egg;  keep  stirring  it  over  the  fire  till  the  mixture  thickens,  but 
do  not  let  it  boil,  or  it  will  be  spoiled. 

16.  Veal  Soup. 

A  knuckle  of  veal,  two  cow-heels,  twelve  pepper-corns,  a  glass  of  sherry,  and  three 
pints  of  water. 

Stew  all  the  ingredients  in  an  earthen  jar  for  six  hours.  Do  not  open  it  till  cold. 
When  wanted  for  use,  skim  off  the  fat,  and  strain  it.  Heat  as  much  as  you  require  for 
use. 

IT.  Good  stock  for  Soup. 

One  pound  of  shin  of  beef,  one  pound  of  knuckle  of  veal,  four  white  peppercorns, 
a  lump  of  sugar,  one  quart  of  water. 

Simmer  gently  for  six  hours,  skim  well  and  strain. 

18.  XouRiSHixG  Soup. 

Stew  two  ounces  of  the  best  well-washed  pearl  sago  in  a  pint  of  water  till  it 
is  quite  tender  and  very  thick,  then  mix  it  with  half  a  pint  of  good  boiling  cream  and 
the  yolks  of  two  fresh  eggs.  Blend  the  whole  carefully  with  one  cjuart  of  essence  of 
beef,  made  according  to  number  3.  The  beef  essence  must  be  heated  scparatelj^  and 
mixed  while  both  mixtures  are  hot.     A  little  of  this  may  be  warmed  up  at  a  time. 

19.  Sago  Soup. 

An  ounce  and  a  half  of  sago,  one  pint  of  stock. 

Wash  the  sago.  Put  one  pint  of  stock  on  the  tire,  and  bring  it  to  the  boil;  add  the 
sago,  and  simmer  till  it  is  entirel}^  dissolved.     When  cold,  it  will  form  a  jelly. 

20.  Rice  Soup. 

Three  ounces  of  Patua  rice,  the  yolks  of  two  eggs,  half  a  pint  of  cream  or  new 
milk,  one  quart  of  stock. 

Boil  the  rice  in  the  stock,  and  rub  half  of  it  through  a  tammy,  put  the  stock  in  a 
stewpan,  add  the  rest  of  the  rice  whole,  and  simmer  gently  for  five  minutes.  Have 
ready  the  cream  or  milli  boiled.  Beat  the  yolks  of  the  eggs,  and  mix  them  gradually 
with  the  cream.  Take  the  soup  off  the  fire,  add  the  cream  and  eggs,  stirring  them 
well  together  as  you  mix  them.  Heat  it  up  gradually,  but  do  not  let  it  boil,  or  the  eggs 
will  curdle,  and  the  soup  be  spoilt. 

21.  Semolina  Soup. 

Drop  an  ounce  of  semolina  into  one  pint  of  boiling  stock,  and  stir  constantly  to 
prevent  burning.     Simmer  gently  for  half  an  hour.     Season  with  salt  to  taste. 

22.  Eaw  Meat  Diet. 

Two  ounces  of  nmipsteak,  taking  away  all  the  fat,  cut  into  small  squares,  -u-ithout 
entirely  separating  the  meat,  place  in  a  mortar  and  pound  for  five  or  ten  minutes,  then 
add  three  or  four  table-spoonfuls  of  water,  and  pound  again  for  a  short  time,  after- 
wards taking  away  all  sinew  or  fibre  of  the  meat,  leaving  only  the  creamy  substance, 
add  salt  to  taste.  Before  using,  place  the  cup  or  jar  containing  the  pounded  meat  in 
hot  water  until  just  warm. 


Or,  scrape  the  beefsteak  with  a  sharp  knife,  and  after  remo\'ing  all  the  fat  and 
tendon,  if  not  already  in  a  complete  pulp  pound  it  in  a  mortar.  This  may  be  taken  in 
the  form  of  sandwich  between  thin  bread  and  butter,  or  mixed  with  water  to  the  con- 
sistence of  cream. 

This  diet  is  excellent  for  children  with  diarrhoea,  also  for  adults  who  suffer  from 
irritable  bowels  or  chronic  diarrhoea. 


Or,  scrape  and  pound  the  meat  with  cold  water  to  consistency  of  thin  cream,  and 
then  allow  to  stand,  and  pour  off  the  supernatant  fluid,  leaving  the  sediment  behind. 


470  DIETARY   FOR    INVALIDS. 

Raw  meat  may  be  made  more  palatable  by  pouring  over  it  a  little  warm  gravy — 
not  too  warm. 

In  cases  of  wasting,  anaemia  and  prostration,  it  is  said  fresh  blood  of  animals — as 
fowls  — mixed  with  warm  wine,  or  milk  punch,  warm  lemonade,  milk  of  coffee,  and 
taken  immediately,  or  before  coagulation,  is  very  useful. 

It  relieves  prostration,  as  in  flooding,  restores  warmth  and  circulation,  acts  better 
and  more  promptly  than  transfusion  from  vein  to  vein.  The  blood  of  two  or  three 
chickeas  should  betaken  in  the  twenty- four  hours. 


Take  half  a  pound  of  lean  rump  steak,  scrape  with  a  knife  imtil  all  the  pulp  is  re- 
moved from  it,  then  add  to  it  as  much  sugar  as  will  be  needed  to  sweeten  it  to  taste, 
break  the  lumps  of  sugar  with  the  meat  in  a  basin,  with  a  small  wooden  spoon.  Add 
gradually  as  much  milk  as  will  make  it  the  thickness  of  arrowroot,  flavor  with  brandy. 
Strain  througli  a  .gravy  strainer  if  there  is  any  fibre  of  the  meat  in  it,  as  the  mixture 
should  be  perfectly  smooth. 

23.  Beef  Tea  and  Ckeam  Exema. 

Mix  four  or  five  ounces  of  strong  beef  tea,  one  ounce  of  cream,  and  half  an  ounce 
of  brandy,  or  one  ounce  of  port  vane. 

24.  Oysters. 

Take  half  a  dozen  native  oysters,  and  put  them  into  a  saucepan  (after  they  have 
been  well  washed  in  cold  water).  Put  in  a  lump  of  butter  the  size  of  a  walnut,  a  little 
salt  and  pepper,  put  the  saucepan  on  the  fire  for  ten  minutes,  not  more,  taking  it  off 
now  and  then  and  stirring  it.     Then  add  a  few  drops  of  lemon-juice  or  vinegar. 

25.  Lobster. 

Take  a  small  claw^  of  a  lobster  or  crab,  and  put  on  it  a  little  salt,  a  quarter  of  a  tea- 
spoonful  of  salad  oil,  and  a  drop  or  two  of  vinegar.  This  is  digestible  even  for  deli- 
cate stomachs. 

26.  Stewed  Eels. 

One  eel,  half  a  pint  of  strong  stock,  two  table-spoonfuls  of  cream,  half  a  glass  of 
port  -wine,  thickening  of  flour,  a  little  cayenne. 

Wash  and  skin  the  eel,  cut  it  in  pieces  about  two  inches  long;  pepper  and  salt  them, 
lay  them  in  a  .stewpan,  pour  the  stock  over,  and  add  the  wine.  Stew  gently  for 
twenty-five  minutes  or  half  an  hour,  lift  the  pieces  carefully  on  to  a  very  hot  dish, 
and  place  it  by  the  fire,  strain  the  gravy,  stir  into  the  cream  sufficient  flour  to  thicken 
it,  mix  with  the  gravy,  boil  for  two  minutes  and  add  a  little  cayenne.  Pour  over  the 
eels,  and  serve.     Sometimes  the  addition  of  a  little  lemon-juice  is  agreeable. 

27.  Stewed  Oysters. 

Half  a  pint  of  oj'sters,  half  an  ounce  of  butter,  flour,  one-third  of  a  pint  of  cream, 
cayenne  and  salt  to  taste. 

Scald  the  oysters .  in  their  own  liquor,  take  them  out,  beard  them,  and  strain  the 
liquor.  Put  the  butter  into  a  stewpan,  dredge  in  sufficient  flour  to  dry  it  up,  add  the 
oyster  liquor,  and  stir  it  over  a  sharp  fire  with  a  wooden  spoon.  When  it  boils  add  the 
cream,  oysters  and  seasoning,  and  simmer  for  one  or  two  minutes,  but  not  lonf/er,  or 
the  oysters  will  harden,  .serve  on  a  hot  dish  with  croutons  or  toasted  sippets  of  bread. 
A  quarter  of  a  pint  of  oysters,  the  other  ingredients  being  in  proportion,  make  a  dish 
large  enough  for  one  person. 

28.  Macaroni. 

Two  ounces  of  macaroni,  a  quarter  of  a  pint  of  milk,  a  quarter  of  a  pint  of  good 
beef  .gravy,  the  yolk  of  one  egc:,  two  table-spoonfuls  of  cream,  half  an  oimce  of  butter. 
Wash  the"  macaroni,  and  l)oil  it  in  the  gravy  and  milk  till  quilr  tender.  Drain  it,  put 
the  macaroni  into  a  very  hot  dish,  and  place  it  by  the  fire.  Beat  the  yolk  of  the  egg 
with  the  cream  and  two  table-spoonfuls  of  the  liquor  the  macaroni  was  boiled  in.  ^Make 
this  sufficiently  hot  to  thicken,  but  cfo  not  alloir  it  to  boil,  or  will  be  spoiled;  pour  it 
over  the  macaroni  and  strew  over  the  whole  a  little  finely-grated  Parmesan  cheese; 
or  the  macaroni  may  be  served  as  an  accompaniment  to  minced  beef  without  the 
cheese;  or  it  may  be  taken  alone  with  some  good  gravy  in  a  tureen  served  with  it. 


dietary  for  iistv^alids.  471 

29.  Minced  Fowl  axd  Egg. 

Cold  roast  fowl,  a  hard-boiled  egg,  salt,  pepper  or  cayenne  to  taste;  three  table- 
spoonfuls  of  new  milk  or  cream,  half  an  ounce  of  butter,  one  table-spoonful  of  Hour, 
a  teaspoonful  of  lemon-juice. 

Miuce  the  fowl,  and  remove  all  skin  and  bones;  piit  the  ])ones,  skin,  and  trimmings 
into  a  stewpan  with  one  small  onion  if  agreeable,  and  nearly  half  a  pint  of  water;  let 
this  stew  for  an  hour,  then  strain  the  liquor,  chop  the  egg  small,  mix  with  the  fowl, 
and  add  salt  and  pepper,  put  in  the  gravy  and  other  ingredients,  let  the  whole  just 
boil,  and  serve  ■«ith  sippets  of  toasted  bread. 

30.  Fowl  and  Rice. 

A  quarter  of  a  pound  of  rice,  one  pint  of  stock  or  broth,  one  ounce  and  a  half  of 
butter,  minced  fowl,  egg,  and  bread  crumbs. 

Put  the  rice  into  the  cold  stock  or  broth,  let  it  boil  very  gently  for  half  an  hour, 
then  add  the  butter,  and  simmer  it  till  quite  dry  and  soft.  When  cold  make  it  into 
balls,  hollow  out  the  inside  and  fill  them  A\ith  mince  made  according  to  the  foregoing 
receipt,  but  a  little  stitfer;  cover  with  rice,  dip  the  balls  into  egg,  sprinkle  with  bread- 
crumbs, and  fry  a  nice  brown;  a  little  cream  stirred  into  the  rice  before  it  cools  improves 
it  very  much. 

31.  Chicken  and  Eice. 

Cut  up  the  meat  of  boiled  chicken,  have  ready  some  rice  well  cooked  and  seasoned 
with  salt,  put  round  a  small  flat  dish,  or  vegetalile  dish,  warm  up  the  chicken  in  a 
little  good  gravy,  and  serve  in  the  middle  of  the  dish  with  the  rice  round  it. 

32.  Panada. 

Take  the  crumb  of  a  penny  roll  and  soak  it  in  milk  for  half  an  hour,  then  squeeze 
the  milk  from  it;  have  ready  an  equal  quantity  of  chicken  or  veal,  scraped  very  fine 
with  a  knife;  pound  the  bread  crumbs  and  meat  together  in  a  mortar.  It  may  be 
cooked  either  mixed  villi  veal  or  chicken  broth,  or  poached  like  an  egg,1)y  taking  it  up 
in  two  spoons  in  pieces  the  shape  of  an  egg,  after  seasoning  it,  and  served  on  mashed 
potato. 

33.  Macaroni  boiled  in  Milk. 

One  ounce  of  macaroni,  three-quarters  of  a  pint  of  new  milk,  a  little  lemon-rind,  a 
little  white  sugar. 

Put  the  milk  into  a  saucepan  with  the  lemon-rind,  bring  it  to  boiling  point,  and 
drop  in  the  macaroni.  Let  it  swell  gradually  over  the  fire  till  quite  tender,  but  do  not 
allow  the  pipes  to  break. 

34.  EicE  Milk. 

Three  table-spoonfuls  of  rice,  one  quart  of  milk. 

Wash  the  rice,  put  it  into  a  saucepan  with  the  milk,  and  simmer  gently  till  the  rice 
is  tender,  stirring  it  now  and  then  to  prevent  the  milk  burning.  Sweeten  a  little,  and 
serve  with  a  cut  lemon,  black  currant  jam,  or  apples  stewed. 

35.  Rice  Cream,  1. 

To  a  pint  of  new  milk  add  a  quarter  of  a  poimd  of  ground  rice,  a  lump  of  butter 
the  size  of  a  walnut,  a  little  lemon-peel,  and  a  table-spoonful  of  powdered  sugar.  Boil 
them  together  for  five  minutes,  then  add  half  an  ounce  of  isinglass  which  has  been  dis- 
solved, and  let  the  mixture  cool.  When  cool  add  half  a  pint  of  good  cream,  whisked 
to  a  froth,  mix  all  together,  and  set  it  for  a  time  in  a  very  cool  place,  or  on  ice.  When 
used,  turn  it  out  of  the  basin  into  a  dish,  and  pour  fruit  juice  round  it,  or  some  stewed 
apples  or  pear  may  be  served  with  it. 

36.  Rice  Cream,  2. 

A  quarter  of  a  pound  of  whole  ijce,  well  slewed  in  milk,  and  put  in  a  sieve  to  drain 
and  cool.  Mix  with  the  rice  a  gill  of  good  cream  whisked  to  a  frotli,  and  add  a  wine- 
glass of  sherry,  a  little  powdered  sugar,  and  a  teaspoonful  of  lemon- juice. 


472  dietary  for  invalids. 

37.  Light  Pudding. 

Boil  very  smoothly  in  new  milk  one  table-spoonful  of  ground  rice,  let  it  get  quite 
cold,  then  add  two  eggs,  very  well  beaten  up,  a  lump  of  white  sugar,  and,  if  liked,  a 
dessert-spoonful  of  brandy.  Line  a  small  tart-dish  (sufficient  for  one  person)  with 
paste,  put  in  the  pudding,  and  bake  quicklj-.  Serve  the  moment  it  is  ready,  for  it 
falls  directly. 

38.  EiCE  AND  Apple. 

Boil  about  two  table-spoonfuls  of  rice  in  a  pint  and  a  half  of  new  milk  and  simmer, 
stirring  it  from  time  to  time,  till  the  rice  is  quite  tender.  Have  ready  some  apples, 
peeled,  cored,  and  stewed  to  pulp,  and  sweetened  with  a  very  little  loaf  sugar.  Put  the 
rice  round  a  plate,  and  the  apple  in  the  middle,  and  serve 

39.  Baked  Custard  Pudding. 

Warm  half  a  pint  of  milk,  or  a  little  more,  whisk  two  eggs,  yolks  and  whites,  pour 
the  milk  to  them,  stirring  all  the  while.  Have  ready  a  small  tart-dish,  lined  at  the 
edges  with  paste.  Pour  the  custard  into  the  dish,  grate  a  little  nutmeg  over  the  top, 
and  bake  it  in  a  very  slow  oven  for  half  an  hour 

40.  Boiled  Custard  Pudding. 

Prepare  the  custrard  as  in  the  foregoing  receipt.  Butter  a  small  basin  that  will  ex- 
actly hold  it,  put  in  the  custard,  and  tie  a  tloured  cloth  over  it;  plunge  it  into  boiling- 
water,  float  it  about  for  a  few  minutes,  boil  it  slowly  for  half  an  hour,  turn  it  out  and 
serve. 

41.    Baked  Bread  Pudding. 

Half  a  pint  of  new  milk,  a  quarter  of  a  pound  of  bread  crumbs,  two  eggs,  one 
ounce  of  butter,  sugar  to  taste. 

Boil  the  milk  and  pour  it  over  the  bread  crumbs,  and  let  them  soak  for  half  an 
hour.  Beat  the  eggs,  mix  them  with  the  bread  crumbs,  and  the  sugar  and  butter,  and 
stir  well  till  thoroughly  mixed.  Butter  a  breakfast  cup,  or  small  pudding  mould,  till 
it  a  little  more  than  half  full  with  the  mixture,  and  bake  in  a  moderate  oven  for  about 
twenty  minutes. 

42.  Semolina  Pudding. 

One  ounce  of  semolina,  half  a  pint  of  milk,  one  ounce  of  butter,  two  eggs,  sugar  ta 
taste. 

Heat  the  milk  and  mix  it  with  the  semolina,  sugar,  and  butter;  stir  this  over  the 
fire  for  a  few  minutes,  then  take  it  off  and  mix  Avith  it  the  eggs,  which  should  be  well 
beaten.  Butter  a  small  tart-dish,  line  it  with  puff  paste,  put  in  the  pudding,  and  bake 
in  a  slow  oven. 

43.  EiCE  Pudding. 

One  ounce  of  whole  rice,  three-quarters  of  a  pint  of  milk,  half  an  ounce  of  butter, 
one  egg,  sugar,  to  taste. 

_  Let  the  rice  swell  in  the  milk  over  a  slow  fire,  stir  in  the  butter,  and  then  let  the 
mixture  cool.  Well  beat  the  (^gg  and  mix  with  the  rice,  butter  a  breakfast  cup  or 
small  mould,  till  it  three  parts  fuU,  and  bake.     Turn  it  out  and  serve. 

44.  Tapioca  Pudding. 

One  ounce  of  tapioca,  one  pint  of  milk,  one  ounce  of  butter,  one  egg,  sugar  to  taste. 

Wash  the  tapioca,  and  let  it  stew  gently  in  the  milk  for  a  quarter  of  an  hour,  stirring 
it  now  and  then.  Let  it  cool,  mix  vAW\  it"the  butter,  sugar,  and  eggs,  which  must  be 
well  beaten.     Put  it  into  a  small  tart-dish;  bake  in  a  moderate  ovem 

45.  Apple  and  Rice. 

Take  three  small  apples,  peel  and  halve  them,  take  out  the  cores,  put  them  into  a 
stewpan  with  about  half  an  ounce  of  butter,  and  strew  over  them  a  little  white  sifted 
sugar.  Stew  them  very  gently  till  tender,  taking  care  not  to  break  them.  Boil  the 
rice  with  milk  and.a  little  sugar  till  quite  soft,  an(f  when  done,  dish  it  with  the  apples 
on  the  top  of  it,  and  a  little  cream  served  with  it  separately. 


DIETARY    FOR    INVALIDS.  473 

4G.    Vermicelli  Pudding. 

Two  ounces  of  vermicelli,  three-quarters  of  a  pint  of  milk,  quarter  of  a  pint  of 
cream,  one  ounce  and  a  half  of  butter,  two  eggs,  one  ounce  and  a  half  of  sugar. 

Boil  the  vermicelli  in  the  milk  till  it  is  tender,  then  stir  in  the  remaining  ingredients. 
Butter  a  small  tart-dish,  line  with  puff  paste,  put  in  the  pudding  and  bake. 

47.    Milk  Blaxcmaxge. 

A  quarter  of  a  pound  of  loaf  sugar,  one  quart  of  milk,  one  ovmce  of  isinglass. 

Put  all  the  ingredients  into  a  lined  saucepan,  and  boil  gently  till  the  isinglass  is 
dissolved.  Keep  stirring  it  over  the  tire  for  about  ten  minutes,  strain  it  through  a  tine 
sieve  into  a  jug,  and  when  nearly  cold  pour  it  into  an  oiled  mould.  Turn  it  carefully 
out  when  required  for  use. 

48.  Junket. 

To  a  pint  of  milk,  heated  till  it  is  lukewarm,  add  a  teaspoonful  of  concentrated 
essence  of  rennet,  and  a  small  teaspoonful  of  pounded  white  sugar.  Pour  it  into  a  bowl 
or  mould,  cover  with  a  napkin,  put  it  aside  to  cool   when  it  is  ready  for  use. 

Concentrated  essence  of  rennet  can  be  bought  at  all  grocers. 

49.  EicE  Blancmange. 

A  quarter  of  a  pound  of  ground  rice,  two  ounces  of  loaf  sugar,  one  ounce  of  butter, 
one  quart  of  milk,  flavoring  of  lemon-peel. 

Mix  the  rice  to  a  smooth  batter  with  a  little  milk,  and  put  the  remainder  into  a 
saucepan  "with  the  butter,  sugar,  and  lemon-peel.  Bring  the  milk  to  boiling  point,  stir 
in  the  rice.  Let  it  boil  for  ten  minutes,  or  till  it  comes  away  from  the  saucepan. 
Grease  a  mould  with  salad  oil,  pour  in  the  rice,  let  it  get  perfectly  cold,  and  turn  out. 

50.  Arrowroot  Blancmange. 

Two  table-spoonfuls  of  arrowroot,  three-quarters  of  a  pint  of  milk,  lemon  and  sugar 
to  taste. 

Mix  the  arrowroot  with  a  little  milk  to  a  smooth  batter,  put  the  rest  of  the  milk  on 
the  fire,  and  let  it  boil.  Sweeten  and  flavor  it,  stirring  all  the  time,  till  it  thickens 
sufficiently  to  come  from  the  saucepan.     Put  it  into  a  mould  till  quite  cold. 

51.  Fruit  Cream. 

Apples,  gooseberries,  rhubarb,  or  any  fresh  fruit.  To  every  pint  of  pulp  add  one 
pint  of  milk,  or  cream,  sugar  to  taste.  Prepare  the  fruit  as  for  stewing,  put  it  into 
a  jar  with  two  table-spoonfuls  of  water,  and  a  little  good  moist  sugar.  Set  this  jar  in 
a  saucepan  of  boiling  water,  and  let  it  boil  till  the  fruit  is  soft  enough  to  mash.  When 
cooked  enough  beat  it  to  a  pulp,  work  this  pulp  through  a  colander,  and  to  every 
pint  stir  in  a  pint  of  milk  or  cream.  Of  course  the  cream  is  best,  if  obtainable. 
Sweeten  and  serve. 

52.  Bread  Jelly. 

Take  the  crumb  of  a  loaf,  break  it  up,  pour  boiling  water  over  it,  and  leave  it  to 
soak  for  three  hours.  Then  strain  off  the  water  and  add  fresh,  place  the  mixture  on  the 
tire,  and  let  it  boil  till  it  is  perfectly  smooth.  Take  it  out,  and  after  pressing  out  the 
water,  flavor  with  anything  agreeable. 

Put  it  into  a  mould,  and  turn  it  out  when  required  for  use. 

53.  Milk  Porridge. 

Put  a  quart  of  milk  into  an  enamel-lined  saucepan.  When  on  the  point  of  boiling 
scatter  in  by  degrees  half  a  pound  of  coarse  oatmeal;  stir  until  the  mixture  thickens. 
When  thickened  let  it  continue  to  boil  about  twenty  minutes.  The  porridge  can  be 
made  thick  or  thin  according  to  taste.  It  can  be  eaten  as  it  is,  or  with  the  addition  of 
salt,  sugar,  treacle,  etc. 


474 


DIETARY    FOR    INVALIDS. 


54.  A  Gruel. 

Beat  up  an  egg  to  a  froth,  add  a  wine-glass  of  sherry,  flavor  with  a  lump  of  sugar, 
a  strip  of  Icmon-pecl,  and  a  little  grated  nutmeg.  Have  ready  some  gruel,  very 
smooth  and  hot,  stir  in  the  wine  and  egg,  and  serve  with  sippets  of  crisp  toast.  Arrow- 
root may  he  made  in  the  same  way. 

55.  Milk,  Egg,  and  Brandy. 

Scald  some  new  milk,  bid  do  not  let  it  boil.  It  ought  to  be  put  into  a  jug,  and  the 
jug  should  stand  in  boiling  water.  When  the  surface  looks  filmy  it  is  suthciently 
done,  and  should  be  put  away  in  a  cool  ]3lace  in  the  same  vessel.  When  quite  cold 
beat  up  a  fresh  egg  with  a  fork  in  a  tumbler,  with  a  lump  of  sugar.  Beat  quite  to  a 
froth,  add  a  dessert-spoonful  of  brandy,  and  fill  up  the  tumbler  with  scalded  milk. 

56.   Egg  and  Wine. 

One  egg,  half  a  glass  of  cold  water,  one  glass  of  sherry,  sugar,  and  a  very  little 
grated  nutmeg. 

Beat  the  egg  to  a  froth  mth  a  table-spoonful  of  cold  water.  IVIake  the  wine  and 
water  hot,  but  not  boiling;  pour  it  on  the  egg,  stirring  all  the  time.  Add  sufficient  sugar 
to  sweeten,  and  a  very  little  nutmeg.  Put  all  into  a  lined  saucepan  on  a  gentle  fire, 
and  stir  it  one  tmy  till  it  thickens,  but  do  not  let  it  boil.  Serve  in  a  glass  with  crisp 
biscuits,  or  sippets  of  toast. 

57.  Milk,  Eum,  and  Isinglass. 

Dissolve  in  a  little  hot  water  over  the  fire  a  pinch  of  the  best  isinglass;  let  it  cool, 
and  mix  a  dessert-spoonful  of  rum  with  it  in  a  tumbler,  and  fill  up  the  glass  with  new 
milk. 

58.  Sherry  or  Brandy  and  Milk. 

To  one  table-spoonful  of  brandy,  or  one  wine-glassful  of  sherry,  in  a  bowl  or  cup, 
add  po-\\^dered  sugar  and  a  very  little  nutmeg  to  taste.  Warm  a  breakfast-cupful  of 
new  milk,  and  pour  it  into  a  spouted  jug;  pour  the  contents  from  a  height  over  the 
wine,  sugar,  etc.     The  milk  must  not  boil. 

59.  Egg  and  Sherry. 

Beat  up  an  egg  with  a  fork  till  it  froths,  add  a  lump  of  sugar  and  two  table-spoon- 
fuls of  water;  mix  well,  pour  in  a  wine-glassful  of  sherry,  and  serve  before  it  gets  flat. 
Half  the  quantity  of  brandy  may  be  used  instead  of  sherry. 

60.  Demulcent  Drink. 

Take  a  pinch  of  isinglass,  and  boil  it  in  half  a  pint  of  new  milk,  with  half  a  dozen 
bruised  sweet  almonds  and  three  lumps  of  sugar. 

61.  Milk  and  Isinglass. 

Dissolve  a  little  isinglass  in  water,  mix  it  well  with  half  a  pint  of  milk,  then  boil 
the  milk,  and  serve  with  or  without  sugar  as  preferred. 

62.  Milk  and  Cinnamon  Drink. 

Boil  in  one  pint  of  new  milk  sufficient  cinnamon  to  flavor  it  pleasantly,  and  sweeten 
with  white  sugar.  This  may  be  taken  cold  with  a  teaspoonful  of  brandy,  and  is  very 
good  in  cases  of  diarrhoea.     Children  may  take  it  milk-warm  without  the  brandy. 

63.  Nutritious  Coffee. 

Dissolve  a  little  isinglass  in  water,  then  put  half  an  ounce  of  freshly-ground  coffee 
into  a  saucepan  with  one  pint  of  new  milk,  which  should  be  nearly  boiling  before  the 
coffee  is  added  boil  both  together  for  three  minutes;  clear  it  by  pouring  some  of  it 
into  a  cup  and  dashing  it  back  again,  add  the  isinglass,  and  leave  it  to  settle  on  the  hob 
for  a  few  minutes.  Beat  up  an  egg  in  a  breakfast-cup,  and  pour  the  coffee  upon  it; 
if  preferred,  drink  it  without  the  egg. 


DIETARY   FOR   INVALIDS.  475 

64.   Arkowroot  Drink. 

Mix  two  teaspoonfuls  of  arrowroot  in  about  three  table-spoonfuls  of  cold  water, 
then  pour  in  half  a  pint  of  boiling  water;  when  well  mixed,  add  by  degrees  half  a 
pint  of  cold  water,  stirring  all  the  time,  so  as  to  make  it  perfectly  smooth;  it  should  be 
about  the  consistence  of  cream;  if  too  thick  a  little  more  water  may  be  added.  Then 
pour  in  two  wine-glassfuls  of  sherry  or  one  of  brandy,  add  sugar  to  taste,  and  give  it 
to  the  patient  in  a  tumbler.     A  lump  of  ice  may  be  added  if  allowed. 

65.  Mulled  Wine. 

Boil  some  spices,  cloves,  nutmeg,  cinnamon,  or  mace,  in  a  little  water,  just  to  flavor 
the  wine;  then  add  a  wine-glass  of  sherry,  or  any  other  wine,  and  some  sugar,  bring  it 
to  boiling  point,  and  serve  with  sippets  of  toast.  If  claret  is  used,  it  will  require  more 
sugar.     The  vessel  for  boiling  the  wine  should  be  scrupulously  clean. 

66.   To  KEEP  Milk  from  turning  Sour. 
Fifteen  grains  of  bicarbonate  of  soda  to  a  quart  of  milk  hinders  it  turning  sour. 

67.  Barley  Water. 

To  a  table-spoonful  of  pearl  barley  washed  in  cold  water,  add  two  or  three  lumps 
of  sugar,  the  rind  of  one  lemon,  and  the  juice  of  half  a  lemon.  On  these  pour  a  quart 
of  boiling  water,  and  let  the  mixture  stand  for  seven  or  eight  hours.  Strain  it.  The 
barley  should  never  be  used  a  second  time.  Half  an  ounce  of  isinglass  may  be  boiled 
in  the  water. 

68.  Lemonade,  1. 

Well  rub  two  or  three  lumps  of  sugar  on  the  rind  of  a  lemon,  squeeze  out  the  juice, 
and  add  to  it  half  a  pint  or  apint  of  cold  or  iced  water,  or,  better  still,  a  bottle  of  soda- 
water. 

69.  Effervescing  Lemonade,  2. 

Squeeze  two  large  lemons,  and  add  a  pint  of  spring  water  to  the  juice,  and  three 
or  four  lumps  of  white  sugar.  When  required  for  use  pour  half  of  it  into  a  tumbler, 
and  add  half  a  small  teaspoonful  of  carbonate  of  soda;  stir,  and  drink  whilst  effervesc- 
ing. 

70.  Lemonade,  3. 

The  juice  of  four  lemons,  the  rinds  of  two,  half  a  pint  of  sherry,  four  eggs,  six 
ounces  of  loaf  sugar,  one  pint  and  a  half  of  boiling  water. 

Pare  the  lemon  rind  thinly,  put  it  into  a  jug  with  the  sugar,  and  pour  the  boiling 
water  on  it.  Let  it  cool,  and  then  strain  it  and  add  the  wine,  lemon-juice,  and  eggs, 
previously  well  beaten  and  strained.     Mix  all  well  together  and  it  is  ready  for  use. 

7L  Lemonade,  4. 

Pare  the  rind  of  three  lemons  as  thin  as  possible,  add  one  quart  of  boiling  water, 
and  a  quarter  of  an  ounce  of  isinglass.  Let  them  stand  till  next  day  covered,  then 
squeeze  the  juice  of  eight  lemons  upon  half  a  pound  of  lump  sugar;  when  the  sugar 
is  dissolved,  pour  the  lemon  and  water  upon  it,  mix  all  well  together,  strain  it  and  it 
is  ready  for  use. 

72.  Arrowroot  and  Black-Currant  Drink. 

Take  two  large  spoonfuls  of  black-currant  preserve,  boil  it  in  a  qviart  of  water, 
cover  it,  and  scew  gently  for  half  an  hour,  then  strain  it,  and  set  the  liquor  again  on 
the  tii'e;  then  inix  a  teaspoonful  of  arrowroot  in  cold  water,  and  pour  the  boiling 
liquor  upon  it,  stirring  meanwhile;  then  let  it  get  quite  cold,  and  strain. 

73.  White  Wine  Whey. 

To  half  a  pint  of  boiling  milk  add  one  or  two  wine-glassfuls  of  sherry;  strain 
through  a  fine  sieve,  sweeten  with  sifted  sugar,  and  serve. 


476  DEETARY   FOR   INVALIDS. 

74.  Caudle. 

Beat  up  an  egg  to  a  froth,  add  a  wine-glassful  of  sherry  and  half  a  pint  of  gruel, 
flavor  with  lemon-peel  and  nutmeg,  and  sweeten  to  taste. 

75.  Another  Caudle. 

Mix  well  together  one  pint  of  cold  gruel  with  a  wine-glassful  of  good  cream,  add  a 
wine-glassful  of  sherry,  and  a  table-spoonful  of  noyau,  and  sweeten  with  sugar-candy. 

76.  EctCt  and  Brandy. 

Beat  up  three  eggs  to  a  froth  in  four  ounces  of  cold  spring  water,  add  two  or  three 
lumps  of  sugar,  and  pour  in  four  ounces  of  brandy  stirring  all  the  time.  A  portion 
of  this  may  be  given  at  a  time. 

77.   Sour  Milk  Diet. 

The  milk  for  this  food  must  be  good.  It  must  be  allowed  to  stand  for  forty-eight 
hours  in  a  cool  cellar;  the  vessel  in  which  it  is  kept  being  upright,  as  a  gallon  meas- 
ure. The  milk  becomes  solid,  and  looks  like  poor  blancmange.  It  carries  a  cream 
on  the  top,  which  most  people  remove  as  it  makes  it  too  rich.  To  about  a  pint  of  this 
sour  milk,  or  rather  less,  add  half  a  pound  of  grated  rye-bread,  a  good  deal  of  pow- 
dered sugar,  and  a  glass  of  sweet  milk,  well  stirred  together. — Hints  to  tlie  Sick 

78.  Oatmeal  Porridge.     Whole-meal  Bread. 

Oatmeal  three  or  four  ounces.  Water  one  pint.  Boil  the  water  and  add  a  little 
salt,  about  one-sixteenth  of  an  ounce.  Sprinkle  in  the  meal  very  gradually  and  care- 
fullv,  till  of  a  sufficient  consistency.  Stir  it  well  all  the  time  with  a  porridge  stick 
(which  should  be  an  inch  broad  at  the  bottom).  Boil  gently  for  fifteen  or  twenty 
minutes,  add  a  little  more  boiling  water,  and  boil  it  five  minutes  longer,  this  makes  it 
smooth.  Pour  it  on  plates  and  "serve.  The  usual  way  is  to  make  a  hole  in  the  mid- 
dle, with  a  spoon,  add  a  piece  of  butter  the  size  of  a  nutmeg,  and  upon  it  a  spoonful 
of  coarse  brown  sugar,  eat  it  from  the  circumference,  and  dip  each  spoonful  into  the 
butter  and  sugar. 

Whole-meal  bread  is  often  useful  in  habitual  constipation,  especially  of  children. 

79.    BURGOUT. 

A  pint  of  water  gradually  added  to  eight  ounces  of  oatmeal.  The  whole  made 
Cjuite  smooth,  and  then  boiled  a  quarter  of  an  hour.  Butter,  salt,  pepper  to  taste. 
Indian  meal  may  be  used  instead  of  oatmeal  if  preferred. 

80.   Port  Wine  Jelly. 

Put  into  a  jar  one  pint  of  port  wine,  one  ounce  of  gum  arable,  one  ounce  of  isin- 
glass, two  ounces  of  powdered  white  sugar-candy,  a  small  piece  of  cinnamon.  Let  this 
stand  closely  covered  all  night  The  next  day  put  the  jar  into  boiling  water  and  let  it 
simmer  till  all  is  dissolved,  then  strain  it,  let  it  stand  till  cold,  and  then  cut  it  up  into 
small  pieces  for  u.se. 

Time,  15  or  20  minutes. — One  pint  of  port  wine,  one  ounce  of  isinglass,  one  ounce 
of  sugar,  a  quarter  of  a  pint  of  water. 

Put  the  isinglass  and  sugar  into  a  quarter  of  a  pint  of  water.  Set  it  over  the  fire  till 
the  isinglass  is  dissolved,  then  add  the  wine.  Strain  it  through  a  jelly  bag  or  a  clean 
piece  of  muslin  into  a  jar  or  mould,  and  let  it  set.     It  is  best  to  cover  till  cold. 

81.  Egg,  Rum,  and  Lemon. 

Six  new-laid  eggs  (with  shells),  the  juice  of  seven  lemons:  macerate  until  the  shells 
are  dissolved.  Then  beat  up  together  with  a  pint  of  the  oldest  Jamaica  rum,  drain 
through  muslin,  and  add  a  quarter  of  a  pound  of  sugar-candy.  The  eggs  should  aU 
be  laid  the  same  day. — Give  a  teaspoonful  at  a  time. 


dietary  for  invalids.  477 

82.  Linseed  Tea. 

Two  table-spoonfuls  of  linseed,  one  pint  of  water,  half  a  lemon,  sugar  to  taste,  a 
piece  of  liquorice  the  size  of  a  nut.     Boil  an  hour  and  a  half. 

83.  Butter  Milk. 

Boil  a  spoonful  of  flour  for  a  few  minutes  in  a  pint  of  butter-milk,  and  add  half  a 
drachm  of  sugar.  This  is  a  good  food  for  infants  with  an  irritable  stomach  and  intes- 
tines. 

Another  diet  for  children  with  delicate  stomachs  and  who  cannot  be  suckled  is  the 
following:  Boil  a  tcaspoonful  of  oatmeal  or  barley  in  from  three  to  six  ounces  of 
water  for  a  quarter  of  an  hour.  Equal  parts  of  this  should  be  added  to  skimmed  milk. 
It  is  usefufin  the  case  of  children  suffei-ing  from  diarrhoea  and  who  pass  curdy 
stools,  to  cut  off  all  forms  of  milk — even  mother's  milk.  Some  doctors  advise  gi\"- 
ing  ci'eam  with  barley  water,  but  in  my  experience  this  food  generally  disagrees. 
Inileed,  I  generally  find  it  necessary  in  all  forms  of  ciiildren's  diarrlioea  to  forbid 
milk,  and  to  give  instead  barley  water  and  veal  broth,  or  chicken  brotii,  or,  best 
of  all,  Nestle's  food,  which  I  find  the  best  of  all  food  for  children  with  great  deli- 
cacy of  the  stomach  and  intestines.  Thin  gruel  is  often  well  borne,  and,  like  bar- 
ley water,  may  be  added  to  chicken  broth  or  veal  broth. 

In  case  of  great  prostration,  as  from  flooding,  Ponfick,  and  recently  Kaczsrow- 
ski,  have  injected,  with  much  success,  defibrinated  blood  into  the  peritoneal  cavity 
instead  of  intravenous  transfusion.     They  inject  250  to  500  centimetres. 


IISTDEX   TO   THERAPEUTIC   AGE:N'TS. 


PAGH 

Acetate  of  Alumina 169 

"  Potash 133 

"  Soda 135 

Acetic  Acid 123 

Acids 122 

Acids  and  Alkalies,  tlieir  action  on  secretions.. .  122 

Acid,  Benzoic '  16 

"      Boric 133 

"      Carbolic 256 

"      Chromic 132 

"      Hydrocyanic  4°4 

"      Nitric 123 

"       Salicylic 44^ 

"      Sulphuric 123 

"      Sulphurous 130 

Aconite 338 

ActEea  Raceniosa 337 

Acupuncture 77 

Adonidin  359 

Affusion 56 

Alcohol 261 

Alkalies 133 

Alkali-.Acid  Theory 122 

Almond  Oil 237 

Aloes 457 

Alum 169 

Ammonia 146 

"  Valerianate  of ....310 

Ammoniacum 310 

Ammonium,  Carbonate  of 146 

"  Chloride 158 

"  Iodide 107 

"  Sulphide 92 

Amyl,  Nitrite  of 292 

Anaesthetics,  Comparison  of 278 

Anise,  Oil  of 306 

Anthelmintics 463 

Antimony,  Salts  of 210 

Antipyrine 453 

Apomorphia 327 

Areca  Nut 463 

Arsenic 215 

Assafcetida 310 

Atropia 400 

Balsam  of  Peru 306 

"  I'olu 306 

Bath,  Steam 62 


PAGE 

Baths,  Cold 38 

"        Cold,  in  Fevers 45 

"        Douches    54 

"        Lamp 61 

"        Mustard 313 

"        Sea 38 

"        Shower 54 

"        Sponge 54 

"        Turkish 58 

"        Vapor  and  Hot  Air 53 

"        Warm  and  Hot 50 

Belladonna 383 

Benzoin 306 

Bicarbonate  of  Potash 133 

"  Soda 133 

Bismuth 180 

Bitartrate  of  Potash 160 

Blisters 81 

Boracic  Acid 133 

Borax 133 

Bromide  of  Ammonium 114 

"        "Sodium 114 

Bromides  114 

Brucia  419 

Buchu 306 

Caffeine 432 

Cajeput  Oil 306 

Calabar  Bean 365 

Calcium,  Sulphide  of 92 

Camphor 301 

Canella  Bark 3o6 

Cannabis  Indica 427 

Cantharides 81,  311 

Capsicum 315 

Caraway  Fruit 306 

Carbolic  Acid 256 

Carbon  (Charcoal) 86 

Carbonate  of  Ammonia 146 

"  Bismuth 180 

"  Lime 151 

"  Magnesia 150 

"  Potash 133 

"  Soda 133 

Carbonic  Acid 88 

Carlsbad  Waters 162 

Cascara  Sagrada 462 

Castor  Oil 244 


480 


INDEX  TO  THERAPEUTIC  AGENTS. 


PAGE 

Castoreum 260 

Caustic  Lime 151 

Potash 133 

Chamomile 456 

Charcoal 86 

Chloral,  Croton 288 

"  Hydrate  of 281 

Chlorate  of  Potash 168 

Soda 168 

Chloride  of  Ammonium 158 

"         JNIethyl 405 

"         Potassium 158 

"         Sodium 158 

Chlorinated  Lime 98 

"  Soda 98 

Chlorine  Gas  9^ 

"       Water 98 

Chloroform 269 

Chromic  Acid 132 

Cinchona 44' 

Cinnamon 306 

Citrate  of  Potash 133 

"  Soda 133 

Cloves 306 

Cocaine 435 

Cocoanut  Oil 237 

Cod-Liver  Oil 237 

Codeia 4^8 

Coffee 432 

Colchicura 335 

Cold 30 

Cold  Bath 38 

Cold  Baths  in  Fevers 45 

Cold  Sponging 55 

Collodion 236 

Colocynth 457 

Conium 361 

Convallaria  Majalis 357 

Copaiba 306 

Copper 206 

Coriander  Fruit 306 

Coto  Bark 253 

Counter-Irritation 81 

Creasote 253 

Croton,  Chloral,  Hydrate  of 2S8 

Oil 244 

Cubebs 306 

Cyanide  of  Potassium 403 

Digitalis 345 

Dill 306 

Douche  Bath 54 

Drinks 71 

Duboisia  Myoporides 403 

Elaterium 457 

Elder 306 

Enemata 74 

Epsom  Salts 160 

Ergot 429 

Ether 278 

Ethidene 277 

Ethyl-Atropium 400 


PAGE 

Ethyl  Strychnia,  &c 422 

Eucalyptus 309 

Euonymus ' 462 

Faradization 78 

Fats 237 

Fennel 306 

Fevers,  Influence  of  Cold  Baths  in 45 

Filix  Mas 463 

Fomentations 62 

Freezing  by  Ether 69,  278 

"        Mixture 68 

Friedrichshall  Waters i6t 

Galbanum 310 

Gallic  Acid 248,  251 

Galvanism 64 

Gelsemium 375 

Glonoin  Cnitro-glycerine) 298 

Glycerine 247 

"  of  Tannin 249 

Grindelia  Robusta 382 

Guaiacum 336 

Hamamelis  Virginica 252 

Hot-Air  Bath 53 

Hot  Bath 50 

Hot  Fiat-Iron,  Application  of ;8 

Hot-Water  Spinal  Bag 69,    71 

Hydrate  of  Chloral 281 

"  Croton  Chloral 288 

Hydrochloric  Acid 123 

Hydrocyanic  Acid 403 

H  yoscine ; 402 

Hyoscyamus 401 

Hypophosphite  of  Lime 158 

"  Soda 158 

Hyposulphites 130 

Ice 67 

Ice-bag  (Spinal) 69 

Incisions  (for  dropsy) 79 

Injections 74 

Iodide  of  Potassium 107 

"  Sodium 107 

"  Ammonium 107 

Iodine 100 

Iodoform 279 

lodol 281 

Ipecacuanha 316 

Iron,  Preparations  of 172 

Irritation 81 

Jaborandi  (Pilocarpine) 372 

Jalap 460 

Juniper 306 

Kamela 463 

Kousso 463 

Lactic  Acid 125 

Lard 237 

Laudanum 405 


INDEX    TO    THERAPEUTIC     AGENTS. 


481 


PAGE 

Lavender 3°6 

Lead  Salts i8i 

Lemons,  Oil  of 3°6 

Lime 151 

"      Carbonate  of i5i 

"      Hypophosphite  of 158 

"      Phosphate  of iS5 

"     Water 151 

Liniment  of  Lime iSi 

Lithium  Bromide 114 

Lobelia  Inflata 426 

Magnesia 15° 

"        Carbonate  of , 150 

"         Sulphate  of 160 

Manganese,  Salts  of 178 

Menthol 306 

Mercury  and  its  Preparations 191 

Methyl-Atropium 400 

"        Chloride 405 

"       Strychnia,  &c 422 

Mezereon 306 

Morphia 405 

Mucuna 463 

Muscarin 368 

Musk 260 

Mustard 313 

Narcein 418 

Narcotine 360,  419 

Nicotia .  .360 

Nitrate  of  Bismuth 180 

"  Potash 165 

"  Silver 187 

"  Soda 165 

Nitric  Acid 123 

Nitrite  of  Amyl 292 

"  Sodium 300 

Nitro-glycerine 298 

Nutmegs 306 

Nutritive  Enemata 75 

Nux  Vomica 419 

Oils,  Castor,  Croton 237 

"     Palm,  Dugong,  Cocoa-nut,  Cod-liver, 

Almond,  Poppy,  Hemp-seed,  Linseed.. 237 

"     Volatile 306 

Oil  of  Tar 253 

Oil  of  Turpentine 303 

Oleate  of  Mercury,  &c 191 

Opium 405 

Oxide  of  Silver 187 

Packing,  Cold  Wet-Sheet 44 

Paper,  Nitre 165 

Paraldehyde 287 

Pareira  Brava 456 

Peppermint 306 

Permanganate  of  Potash 179 

Peru,  Balsam  of 306 

Petroleum 253 

Phenacetin 455 

Phosphate  of  Lime 155 

31 


Phosphate  of  Soda 160 

Phosphide  of  Zinc 238 

Phosphoric  Acid 129 

Phosphorus 232 

Podophyllum 333 

Pomegranate 463 

Potash 133 

"      Acetate  of 133 

"      Bicarbonate  of 133 

"      Carbonate  of 133 

"      Chlorate  of 168 

"      Citrate  of 133 

"      Nitrate  of 165 

"      Permanganate  of 179 

"      Sulphate  of , 160 

"      Tartrate  of 160 

Potassium,  Bromide 114 

"  Chloride 158 

"  Cyanide 404 

"  Iodide 107 

"  Sulphide .• 92 

Poultices 62 

Pullna  Water 161 

Purgative  Salts  and  Waters 160 

Quassia 456 

Quinia 441 

"       Valerianate  of 310 

Quinidinia 446 

Raspail's  Lotion 147 

Rhubarb 461 

Rosemary 306 

Rue 306 

Sabadilla  (Veratria) 328 

Saccharated  Solution  of  Lime 151 

Salicine 448 

Salicylates 448 

Salicylic  Acid 448 

Salol 452 

Salts,  Potassium  and  Sodium 104 

Sandalwood  Oil 306 

Santonin 463 

Sassafras 306 

Scammony 460 

Sea-bath 38 

Senega 463 

Senna 462 

Shower-bath 54 

Silver  Salts 187 

Sitz-bath 43 

Soap 133 

Soda,  Acetate  of 133 

'      Carbonate  of 1 33 

"      Caustic 133 

"       Citrate  of 133 

"      Hypophosphite  of 158 

"      Nitrate  of 165 

"      Nitrite  of 300 

Soda,  Phosphate  of 160 

"       Solution  of 133 

"      Sulphate  of 160 


482 


INDEX   TO    THERAPEUTIC   AGENTS. 


PAGE 

Sodium,  Chloride 158 

"        Iodide 107 

"        Sulphide 92 

Sparteine 358 

Spearmint 3°^ 

Spinal  Hot-water  Bag 69,  71 

"      Ice-Bag 69 

Spirits  of  Ammonia 146 

Sponge  Bath 54 

Squill 460 

Steam  Bath 62 

Storax 3°6 

Stramonium 4°3 

Strophanthus 357 

Strychnia 4^9 

Suet 237 

Sulphate  of  Magnesia 160 

"  Potash 160 

"  Soda 160 

Sulphides 92 

Sulphites 130 

Sulphur 88 

Sulphuric  Acid 123 

Sulphurous  Acid 130 

Tannin 248 

Tar 253 


PACK 

Tartar  Emetic 210 

Tartrate  of  Potash 160 

"         ■'        "      and  Soda 160 

Thebaia 419 

Thermic  Hammer 78 

Tin,  Powdered 463 

Tobacco 360 

Tolu 306 

Turkish  Bath 58 

Turpentine 303,  463 

Urethan 288 

Valerian 310 

Valerianates 310 

Vapor  Bath 53 

Vaseline 253 

Veratria 328 

Veratrum 327 

Volatile  Oils 306 

Warm  Baths 5° 

Water 7' 

Wax 237 

Wet-sheet  Packing 44 

Zinc,  Preparations  of 207 


I^DEX  TO   DISEASES. 


ABSCESS. 

When  large  and  deep-seated  abscess  is  suspected 
the  thertnometer  may  assist  in  diagnosis. 
See  p.  29. 

Belladonna,  387.     Internally  often  successful. 

Caustic  alkalies,  136.  For  opening  abscesses, 
for  precautions,  see  ref. 

Counter-irritation,  84.  By  blisters  or  iodine 
around  or  adjacent  to  the  disease. 

Ether,  278.  As  spray  to  produce  local  anaes- 
thesia for  opening  abscesses. 

Fo.mentations,  148.  With  solution  of  20  grs. 
carb.  ammon.  to  one  pint  of  boiling  water  for 
threatened  mammary  abscess. 

Iodine,  202.  Solution  of  tinct.  injected  into  cav- 
ities of  large  abscesses  after  evacuation. 

Oleate  of  mercury  anij  morphia,  195.  Locally, 
diminishes  induration  due  to  old  abscesses  and 
prevents  formation  of  new  ones. 

Permangan.\te  of  potash,  102.  A  weak  solu- 
tion for  washing  out  cavities  of  large  abscesses 
after  iodine  injections. 

Phosphate  of  lime,  156.     In  large  abscesses. 

Poultices,  63.  To  check  formation  of  pus  or  to 
assist  in  maturation.  iVIay  be  covered  over  with 
belladonna  or  opium. 

Sulphides,  94-96. 


ACIDITY. 

Acids,  122.     Given  shortly  before  a  meal. 

,  125.  Hydrochloric  or  nitric  in  small  me- 
dicinal doses  before  meals  for  acidity  from  what- 
ever cause  it  arises,  especially  for  acid  pyrosis  ; 
after  meals  for  alkaline  pyrosis. 

Alk.\lies,  138.  Only  palliative  ;  bicarbonates 
best  ;  if  the  escape  of  carbonic  acid  is  trouble- 
some, substitute  magnesia  if  bowels  confined, 
lime-water  if  relaxed. 

Bismuth,  180.  The  nitrate  combined  with  mor- 
phia or  opium,  and  sometimes  with  magnesia. 

Ipecacuhana,  318.     In  acidity  of  pregnancy. 

Magnesiv,  150.  The  oxide  better  than  the  car- 
bonate— only  a  temporizing  remedy — acids  far 
better. 

Mercury,  199.  Half  a  grain  of  gray  powder 
three  times  a  day  when  accompanied  by  clayey 
stools. 

Nux  voMic.'^,  126.  Two  or  three  drops  just  before 
meals  in  acidity  of  pregnancy. 


ACNE. 

Arsenic,  121.  |Liq.  arsen.  given  with  bromide 
prevents  its  causing  bromic  acne. 

Belladonna,  387.   Locally,  of  some  slight  service. 

Bromide  of  potassium,  114. 

Hot  fomentations,  66. 

Hot  sponging,  67.     B'or  acne  indurata. 

Iodide  of  sulphur,  121.  An  ointment  in  a.  in- 
durata and  rosacea,  also  in  bromic  acne,  97. 


AC  N  E — con  tinned. 

Mercury,  193.  In  early  stages  a  lotion  of  cor- 
rosive sublimate,  one  part  ;  alcohol,  enough  to 
dissolve  it  ;  water,  100  parts.  A  teaspoonful  of 
this  to  be  added  to  a  quarter  of  a  pint  of  water 
and  the  face  sponged  with  it  night  and  morning. 

Phosphorus,  235.     In  acne  indurata. 

Soap,  135.  With  hot  water  several  times  a  day. 
If  this  irritates,  rub  in  glycerine  of  starch  after 
each  washing. 

Sulphur,  90.  As  lotion  for  young  women  with 
disordered  menstruation.  In  severe  forms  an 
ointment  of  hypochlorite  or  iodide  of  sulphur. 

,  90.     Sulphur  may  be  used  internally. 


AGUE. 

Arsenic,  230.  The  best  remedy  except  quinine. 
Especially  useful  in  long-standing  agues  of 
quartan  type. 

Chamomile,  456.     Has  been  used. 

Emetics,  212.  Many  cases  may  be  cured  by 
emetics,  and  one  each  morning  will  assist  the 
action  of  quinine.  Ipecac,  and  other  emetics 
should  be  preferred  to  antimony. 

Eucalyptus,  310.     Inferior  to  quinine. 

Hyposulphite  of  soda,  132.  Fifteen  to  twenty 
grains  every  two  hours. 

Narcotine,  419.  Said  by  some  to  be  superior  to 
quinine. 

Nitrhe  of  sodium,  301.     To  avert  cold  stage. 

Nitro-glycerine,  300.     To  avert  cold  stage. 

Quassia,  456.     Has  been  used. 

Quinia,  444.  By  far  the  best  remedy  we  possess 
for  intermittent  fevers. 

In  mild  forms  small  doses  several  times  a  day. 
I  n  malignant  forms  large  doses  given  in  a  non- 
febrile  period,  445. 

The  drug  should  not  be  discontinued  for  some 
time  after  all  symptoms  have  disappeared. 
It  is  of  service  as  a  prophylactic  against  ague. 
It  may  be  administered  hypodermically  or  by 
the  rectum — ether  is  the  best  solvent  for  injec- 
tion. 

Cinchona,  quinidinia  and  cinchonidinia,  are 
all  useful  in  ague,  but  less  so  than  quinia,  446. 

Salicylic  acid,  451.     As  an  adjunct  to  quinia. 


ALCOHOLISM.     {See  Dipomania.) 

Act.«:a,  337.     In  drunkard's  stomach. 

Arsenic,  3.  Indicated  by  red,  clean,  smooth,  ir- 
ritable tongue. 

,  222.     For  vomiting. 

Cocaine,  440.     Internally. 

Morphia,  410.  With  tonics  before  meals  for 
pain,  nausea,  and  want  of  appetite. 

Phosphorus,  235.     In  chronic  alcoholism. 

Strychnia,  424.  Hypodermically  in  increasing 
doses  has  been  highly  recommended. 


484 


INDEX    TO    DISEASES. 


AMAUROSIS.     {See  Eye  Diseases.) 


AMENORRHCEA. 

Aconite,  345.     When  menses  suddenly  checked. 

AcT.-EA  R.\ciiMOSA,  337.  Generally,  and  when 
menses  checked. 

Aloes,  459.  At  the  periods,  together  with  hot 
pediluvia,  friction,  stimulating  liniments,  &c. 
For  general  directions  see  ref. 

Chlokide  of  ammonh'm,  159.     For  headache. 

Cold  sponglng,  55. 

Ergot,  431.  Where  anaemia — after  the  use  of 
iron. 

Hot  sitz-bath,  52.  For  six  days  before  the  pe- 
riod. Mustafd  may  be  added  at  the  period. 
Often  effectual  in  sudden  suppression. 

Iron,  176.     To  remedy  the  anaemia. 

Mustard,  314.  A  mustard  sitz-bath  a  few  days 
before  and  during  the  time  the  missing  dis- 
charge is  due.  A  course  of  these  baths  assists 
the  restoration  of  the  uterine  functions. 

PER.^LA^■G.•^NATE,  179.  Useful  when  flux  scanty 
or  delayed,  or  even  when  absent  for  a  long  pe- 
riod. It  may  restore  it  after  two  years.  Also 
■when  a  chill  prevents  or  delays  flow.  It  acts 
with  plethoric  as  well  as  with  anaemic  patients. 
I  gr.  in  pill  thrice  daily  till  catamenia,  then  dis- 
continue till  four  days  before  next  period  due 
and  continue  till  flow  ceases. 

Santonine,  465.  A  10  gr.  dose  on  two  successive 
nights,  especially  when  chloro-anaemia. 

Spinal  ick-bag,  70.  Applied  to  lower  dorsal  and 
lumbar  vertebrae. 


AN/EMIA. 

Acids,  128.  Added  to  purgative  salts  as  tonic  to 
mucous  memb. 

Cold  sponging,  56. 

HvpoPHOSPHiTES,  158.     Of  lime  or  soda. 

Iron,  173.  Some  stomachs  with  irritable  mucous 
memb.  require  bland  preparations.  A  flabby 
tongue  indicates  large  doses  of  astringent  prep- 
arations, as  perchloride  or  sulphate.  See  also 
p.  3.  Weak  anaemic  girls  with  pain  and  vomit- 
ing after  food  require  larger  doses  of  the  tinct. 
perchlor.,  173.  It  is  sometimes  well  to  humor 
the  stomach  by  changing  the  preparation.  Some 
persons  are  quite  unable  to  take  iron  in  any 
form,  176.  Iron  may  be  given  in  anaemia  with 
disturbance  of  uterine  functions,  and  should  be 
conjoined  with  nourishing  food,  pure  air.  light, 
and  if  necessary,  purgatives.  If  the  anaemia  is 
due  to  organic  disease,  iron  at  best  only  pallia- 
tive. 

Phosphate  of  lime,  156.  In  anaemia  of  grow- 
ing persons,  and  of  women  weakened  by  rapid 
child-bearing  or  excessive  menstruation. 

QuiNiA,  448.     For  badly  fed,  pale  town-livers. 


ANEURISM. 

Chloroform,  276.    Inhalation,  if  great  dyspnoea. 
Iodide  of  potassium,  112.     Combined  with  re- 
cumbent position  and  restricted  diet. 


ANGINA  PECTORIS. 

Arsenic,  230.     Lessens  severity  of  attacks. 

Ether,  27S.  Or  spirits  of  chloroform  in  full  doses 
very  useful. 

Morphia,  407.     Hypodermically. 

Nitrite  of  amyl,  294.  Inhalation  most  valu- 
able. 

Nitrite  of  sodium,  300.  i  gr.  several  times  a 
day. 

Nitro-gyclerine,  300.  Often  superior  to  amyl, 
being  more  persistent  in  its  effects.  i-iooth 
min.  in  water  or  in  a  tablet  at  stated  intervals, 
and  an  additional  dose  on  onset  of  paroxysm. 


ANGINA    VY.CT ORIS— continued. 

Phosphorus,  235.     Often  serviceable. 
Sodium  iodide,  112.     Has  been  tried. 


ANTHELMINTICS.     {See    IVorms.) 

ANUS,  PAIN  AFTER  OPERATIONS 
AT. 

Ice,  68.     Applied  in  bladder. 
ANTHRAX. 

C.'^RBOLIC  ACID,  258.     Topically. 
Salicylic  acid,  449.     Less  efficacious  than  car- 
bolic acid. 


AORTIC    DISEASE.      {See   Heart  Dis- 


eases.) 


APHTHA. 

Alum,  170.  Applied  dry  a  few  times  a  day  to 
aphthous  ulcers  which  will  not  heal  —generally, 
however,  chlorate  of  potash  and  a  purgative 
sufficient. 

Borax,  138.    With  honey  or  as  glycerine  of  borax. 

Chlorate  of  potash,  168 

Glycerine  of  borax,  247. 

Nitric  .\cid,  124.     In  small  doses. 


APOPLEXY. 

Croton  oil,  246.     As  purgative  one-fourth  or 
one-third  minim  every  hour. 


APPETITE,  LOSS  OF.  {See  Dyspepsia.) 


ASCITES. 

Copaiba,  308.     In  some  forms  of  ascites. 
Elaterr  .M,  457.     Must  be  given  with  caution. 
Calomel,  206. 


ASTHMA  AND  QUASI-ASTHMA. 

Aconite,  341.  Given  at  commencement  of  the 
fever  often  averts  the  attack.  L'seful  also  in 
the  asthma  following  coryza  and  sneezing  in 
children. 

Alum,  170.  Ten  grs.  powdered  and  placed  on 
the  tongue  said  to  arrest  a  paroxysm. 

Antimony,  213.  In  an  affection  of  children  like 
asthma  (see  ref.);  dissolve  a  grain  of  tartar- 
emetic  in  half  a  pint  of  water,  and  give  a  tea- 
spoonful  of  this  every  quarter  of  an  hour  for 
the  first  hour,  then  hourly.  If  vomiting  in- 
duced, lessen  the  dose. 

Arsenic,  216,  217.  As  cigarettes,  caution  re- 
quired (see  ref.),  also  one  drop  of  liq.  arsen. 
three  times  a  day  in  attacks  of  sneezing  with 
coryza,  frontal  headache  and  itching  of  nostrils. 
These  attacks  may  be  brought  on  by  cold,  by 
meals,  by  local  irritation,  or  in  children  are  con- 
sequent on  bronchitis.  These  cases  are  allied 
to  dyspeptic  and  bronchitic  asthma,  and  to 
hay  fever  (see  ref.  218,  219) 

Assafcetida,  310. 

Belladonna,  393.  Large  doses  required,  but 
very  satisfactory  (see  ref.). 

Blisters,  83.  For  oppression  of  breathing  es- 
pecially in  bronchitic  asthma. 


INDEX    TO    DISEASES. 


485 


ASTHMA,  'E'VC.—cofttimied. 

Cannabis  indica,  429.     Has  been  found  useful. 

Carbonic  acid  gas,  88.     As  inhalation. 

Chamois  leather  waistcoat,  59. 

Chloral,  285.  Often  useful  in  a  full  dose  dur- 
ing a  paro.\ysm. 

Chlorate  of  potash,  166.  With  nitre  to  satu- 
rate blotting  paper,  or  a  pastile  may  be  made  of 
chlorate  and  nitrate  of  potash  with  lycopodium. 

Chlokofokm,  270.     Often  combined  with  opium. 

,  276.  As  inhalation  if  great  dys- 
pnoea. A  few  whiffs  will  sometimes  avert  a 
paroxysm.  '  As  liniment  rubbed  on  chest  for  an 
hour  daily  in  bronchitic  asthma. 

Coffee,  433.  A  small  cup  of  very  strong  coffee 
often  useful  in  a  paroxysm. 

CoLCHicuM,  330.     In  gouty  subjects. 

Counter-irritation,  81. 

Ether,  278. 

Eucalyptus,  309.     As  cigarette. 

Gelsemium,  382.     Sometimes  beneficial. 

Grindei.ia  robusta,  382.  Three  grs.  of  extract 
thrice  daily  to  prevent  attacks,  or  m.  xx  to  m. 
XXX  of  liquid  extract  every  half-hour  or  hourly 
from  onset  of  paroxysm. 

Iodide  of  methyl,  107. 

Iodide  of  potassiu.m,  107.  Two  per  cent,  solu- 
tion as  spray. 

Iodide  of  potassium,  107.  In  peptic  and  bron- 
chial asthma. 

Ipecacuh.\na,  321.  The  wine  as  spray  to  the 
fauces  sometimes  useful  in  severe  bronchial 
asthma,  but  not  of  much  service  in  genuine 
asthma — for  Dr.  Hyde  Salter  s  observations  on 
the  general  management  of  asthma,  see  p.  325. 

Lobelia,  426.  Ten  drops  of  the  simple  tincture 
every  ten  minutes  or  quarter  of  an  hour  as  soon 
as  signs  of  a  paroxysm  appear  till  the  dyspnoea 
gives  way. 

In  bronchitic  asthma  where  breathing  a  little 

tight  all  day  but  much  worse  at  night,  ten  min. 

three  times  a  day  with  additional  doses  at  night. 

This  drug  must  be  given  cautiously  when 

there  is  heart  disease. 

Nitrate  of  potash,  165.  The  inhalation  of 
fumesof  burnt  nitre  paperwill  sometimes  avert 
a  paroxysm.  Different  methods  of  preparation 
useful  for  different  cases  (see  ref.). 

Nitrite  of  amyl,  293.     As  inhalation. 

Nitrite  of  sodium,  301.  In  nervous  and  bron- 
chial asthma  and  that  of  Bright's,  but  useless 
where  emphysema. 

Nitro-glycerine,  300.     In  the  paroxysms. 

Opium,  417.  In  some  cases.  In  others  morphia 
will  induce  a  paroxysm. 

Pilocarpine,  374.     Hypodermically. 

Silver,  nitrate  of,  189.  Sometimes  injected 
into  trachea  (see  ref. ). 

Stramonium,  403.  Twenty  grs.  of  the  dried 
leaves  or  ten  of  the  powdered  root  may  be 
smoked.  Datura  tatula  sometimes  better. 
Stramonium  preparations  often  bad.  Asthmat- 
ics advised  to  grow  the  drug  themselves. 

Sulphurous  acid,  131.  Inhalation,  spray  or 
fumigation. 

Tobacco,  361.     Smoking  sometimes  gives  relief. 

Turkish  baths,  59.     In  bronchial  asthma. 


BALDNESS. 

Pilocarpine,  374.     Locally.     With  cantharides 
«ind  soap  liniment,  (see  formula). 


BARRENNESS. 

Iodide  of  potassium,  hi.   When  due  to  syphilis. 

BED-SORES. 

Alcohol,  261.     As  brandy  or  eau  de  Cologne  to 
harden  skin  of  parts  exposed  to  pressure. 


BED-SORES — continued. 

Catechu,  249.  The  tincture  with  liq.  plumbi  lo- 
cally to  prevent  sores. 

Charcoal,  66.  Sprinkled  over  the  black  slough, 
which  is  then  covered  with  a  poultice. 

Glycerine,  247.  Or  glycerine  cream  rubbed  over 
part  exposed  to  pressure  after  washing  morning 
and  evening,  is  one  of  the  best  preventives  of 
bed-sores. 

Iodoform,  279.     Dusted  over  sores. 

Silver,  nitrate  of,  187.  A  solution  twenty  grs. 
to  the  oz.  to  be  painted  on  threatened  but 
unbroken  skin  as  soon  as  it  becomes  red  to 
prevent  formation  of  bed-sores. 

If  nitrous  ether  solution  used,  five  grs.  to  the 
oz.  enough,  1S8,  189. 


BILE,  DEFICIENCY  OF. 

Mercury,    190,   200.     Frequent   small   doses  of 
gray  powder. 


BILIARY  COLIC.     {See  Colic.) 

BILIOUS      HEADACHE.        {See    Sick 
Headache.) 

BITES. 

Ammonia,  147.  Weak  solutions  in  bites  of  insects 
to  neutrahze  the  formic  acid. 

BLADDER,  DISEASES  OF. 

Copaiba,  308.  Also  cubebs  and  buchu  in  chronic 
inflammation  of  bladder  and  urethra. 

Iodoform,  279.  As  suppository  in  painful  dis- 
eases. 

Sulphites,  132.  Internally  prevent  putrefaction 
of  urine. 


BLEEDING.     {See  Hccmorrhage.) 


BOILS. 

Belladonna,  96.  With  glycerine  locally  to  allay 
pain. 

,  387.     Internally  often  successful. 

Camphorated  alcohol,  301.  Boils  in  the  earli- 
est stages  to  be  smeared  with  this  for  half  a 
minute,  then,  when  the  skin  is  dry,  it  is  to  be 
smeared  with  camphorated  oil.  A  few  applica- 
tions said  to  disperse  the  coming  boil. 

Collodion,  236.  Applied  at  papular  or  pustular 
stage.  ^Iatter  not  to  be  let  out  except  under 
Lister's  plan  (see  ref.). 

CouNTER-iRKiTATioN,  84.  By  blisters  or  iodine 
around  the  boil. 

Menthol,  307.  As  10-50  per  cent,  solution  lo- 
cally 

Opium,  408.  An  extract  of  the  consistence  of 
treacle  locally  applied  three  or  four  times  a  day 
(see  ref.). 

Poultices,  63.  To  assist  maturation  and  allay 
pain,  may  be  smeared  over  with  belladonna  or 
opium. 

Silver,  nitrate  of,  188.  In  boils  beginning  as 
a  papule  which  maturate  into  a  pustule  and  in- 
flame and  extend  till  large  dead  core  produced. 
To  be  painted  on  at  commencement — collodion, 
perhaps,  better  for  these. 

Sulphides,  95.  Hasten  maturation  and  prevent 
formation  of  fresh  boils.  No  use  in  the  boils  o£ 
diabetes. 


486 


INDEX    TO    DISEASES. 


BONES,  DISEASES  OF. 

Cod-liver  oil,  241.     In  strumous  disease. 
Phosphate  ok  lime,  156.     In  caries. 

BRAIN,      DISEASES     OF.       (See    also 
Paralysis.) 

Bromide  of  potassium,  117.  When  over-taxed 
from  study,  or  over-application  to  business. 

Phosphorus.  235.  In  cerebral  softening,  also  in 
over-taxation. 

BREASTS,  INFLAMMATION  OF. 

Belladonna,  383.  Especially  as  liniment  to 
check  secretion  of  milk  when  inflammation  im- 
minent. When  inflammation  has  set  in,  con- 
tinuous application  of  belladonna  for  twenty- 
four  hours  often  arrests  it.  It  is  also  useful 
when  an  abscess  has  formed.  Fomentations 
useful  in  addition,  but  skin  must  be  dried  well 
before  the  belladonna  is  rubbed  in. 

DiGiT.ALis,  355.     Infusion  locally. 


BREATH,   FOUL. 

Camphor,  301. 


BRIGHT'S  DISEASE. 

Aconite,  343.  Should  be  given  immediately  on 
the  appearance  of  inflammation  of  the  kidneys 
in  scarlatina. 

Alkalies,  144.  Citrates  and  acetates  in  acute  and 
chronic  Bright's,  being  reputed  to  act  as  diu- 
retics. 

BiTARTRATE  OF  POTASH,  164.  To  prevent  dan- 
gerous accumulations  in  cellular  tissue  or 
important  cavities.  Also  to  draw  off  effete 
matters.  Care  must  be  used,  as  it  is  a  brisk 
purgative  and  so  is  weakening. 

Bromide  of  potassiu.m,  115.     For  convulsions. 

Cannabis  indica,  429.  In  acute  and  chronic 
forms  as  a  diuretic,  said  to  be  specially  useful 
where  bloody  urine. 

Cantharides,   3:2.      After  subsidence  of  acute 
stage,  a  one  min.  dose  every  three  hours  will 
stop  the  hsematuria. 
.    Cod-liver  oil,  241.     In  chronic  forms. 

Copaiba,  308.  Sometimes  useful  in  removing 
dropsy. 

Digitalis,  353.  Very  valuable  in  some  cases  ; 
only  diuretic  as  long  as  dropsy  exists. 

Elaterium,  457.  For  the  dropsy — caution  re- 
quired. 

Incisions,  51.  For  dropsy  better  than  hot  baths. 
Hot  fomentations  with  boracic  acid  may  be 
employed  afterwards. 

Iodide  of  potassium,  hi.  Possibly  only  when 
due  to  syphilis. 

Iron,  3.  Astringent  preparations  when  tongue 
flabby  and  pale. 

Jaborandi,  374.  Especially  on  occurrence  of 
ursemic  symptoms.  If  urjemia  urgent,  pilocar- 
pine may  be  injected  hypodermically. 

Le.\d,  186.     Diminishes  the  albumen. 

Senega,  463.     As  a  diuretic. 

Tan.nin,  251.  In  chronic  Bright's  to  lessen 
albumen. 

Tartrates,  164.     Excellent  diuretics. 

Turkish  bath,  58. 

Warm  baths,  51.  When  uraemic  symptoms  or 
dropsy  well  marked  (see  ref.).  Discretion 
needful. 


BRONCHITIS. 

Aconite,  343.     In  measles. 

Acids,  130.     To  lessen  secretion  in  chronic  form. 

Actea,  337,     As  an  expectorant. 


'QRO'y.ClllTlS—cojiiinned. 

Ammonia,  148.  Inhalation  in  chronic  bronchitis 
to  lessen  over-abundant  expectoration. 

Ammoniacum,  311.  In  bronchitis  with  wheezing 
and  abundant  discharge  in  old  people. 

Antimony,  15.  Small  frequent  doses  of  tartar- 
emetic  where  skin  dry  and  hot. 

,  213.    To  shorten  acute  bronchitis  (see 

Inflammation).   Also  in  chronic  bronchitis  when 
expectoration  copious  and  difficult  to  expel. 

Arsenic,  226.  Where  emphysema,  with  wheezing 
and  not  much  bronchitis,  especially  where  the 
wheezing  has  come  on  simultaneously  with  the 
retrocession  of  a  rash  as  of  eczema :  where 
much  bronchitis  and  dyspnoea,  belladonna  and 
lobelia  better. 

Assafcf.tida,  311.  For  old  people,  but  ammoni- 
acum generally  better. 

Balsam  of  tolu  or  Peru,  or  copaiba,  307.  In 
chronic  bronchitis  to  lessen  secretion. 

Benzoic  acid,  307.  3  j  in  boiling  water  as  in- 
halation. 

C.\rbolic  acid,  254.  Or  creasote,  twelve  to 
twenty  drops  as  inhalation  with  boiling  water 
for  abundant  expectoration  or  fcetor. 

Carbonate  of  ammonia,  149.  When  expec- 
toration profuse  and  patient's  strength  dimin- 
ishing, often  given  with  chloride  of  ammonium, 
which  acts  similarly ;  also  useful  in  severe 
bronchitis  or  broncho-pneumonia  of  children, 
especially  when  prostrate  and  livid. 

Carbonic  acid  gas,  88.  As  inhalation  in  chronic 
bronchitis. 

Chamois  leather  waistcoat,  59.  Worn  over 
flannel  in  bronchial  asthma  and  emphysematous 
bronchitis. 

Chloride  of  ammonium,  159.  In  chronic  bron- 
chitis when  secretion  thick  and  abundant. 
May  be  applied  by  atomizer. 

CoD-LivER  oil,  242.  To  Control  expectoration 
in  chronic  bronchitis. 

Colchicum,  332.     In  gouty  subjects. 

CoNiUM,  362.  Inhalation  in  boiling  water  for 
irritable  cough. 

Counter-irri  lANTS,  83.  For  shortness  of  breath 
in  bronchitic  asthma  and  bronchitis  with  em- 
physema. 

Croton  oil,  244,  243.  With  or  without  liq. 
potassae  as  counter-irritant  to  chest — caution 
needful. 

Essential  oils,  307.  Balsam  of  Peru,  tolu  and 
copaiba  in  chronic  bronchitis  with  copious 
secretion  of  pus. 

Eucalyptus,  309,  Often  relieves  cough  of  chronic 
bronchitis. 

Gi^\iACUM,  336.     Has  been  employed. 

Iodine,  100.  The  liniment  to  the  chest  to  lessen 
cough  and  expectoration  in  chronic  bronchial 
catarrh.  -As  inhalation  for  children  with  hoarse, 
hollow  cough  after  measles,  <S;c.  Inhalation 
sometimes  employed  in  chronic  bronchitis. 

Ipecacuanha,  317,  318.  '1  o  produce  vomiting  in 
children  with  much  mucus  in  bronchial  tubes. 

,  321.     As  wine,  when  expectoration 

is  profuse  and  difficult  to  expel. 

The  wine  used  as  spray  to  the  pharynx  in- 
valuable in  many  cases  of  bronchial  asthma  and 
winter  cough  (see  ref.). 

Iron,  177.     To  check  profuse  bronchial  secretion. 

J.^lap,  461.  With  bitartrate  of  potash  to  free 
purgation  for  cases  where  the  right  heart  is 
engorged  from  emphysema,  bronchitis,  &c. 

Lead,  186.    To  check  profuse  bronchial  secretion. 

Lobelia,  427.     For  paroxysmal  dyspna:a. 

Mustard,  314.  As  large  poultice  with  linseed  or 
oatmeal  in  acute  bronchitis,  or  a  tablespoonful 
added  to  a  bath,  very  useful  in  severe  bronchitis 
both  of  children  and  adults. 

Opiates,  409.  Where  frequent  and  violent  cough 
without  any  signs  of  obstructed  oxidation. 

,  417.     To  check  excessive  secretion. 

Phosphate  of  li.me,  156. 

Poultices,  63.  To  encircle  the  whole  chest  in 
children. 


INDEX    TO    DISEASES. 


487 


BRO'SCniTIS—con^inui^J. 

QiiNiA,  446.     To  reduce  temperature. 

Senega,  463.  Especially  for  the  chronic  bron- 
chitis of  the  aged. 

Silver,  nitrate  of,  1S9.  Sometimes  injected 
into  trachea  (see  ref.). 

Spinal  ice-  bag,  70.     For  excessive  secretion. 

Squill,  460.     As  an  expectorant. 

Sulphur,  qi.  Five  to  ten  grs.  in  severe  chronic 
bronchitis  with  abundant  discharge,  especially 
where  constitutional  debility. 

Sulphurous  acid,  131.  Inhalation,  spray  or 
fumigation  in  chronic  bronchitis. 

Tar,  255.  Two  grs.  in  pill  every  three  or  four 
hours  in  chronic  paroxysmal  winter  cuugh.  Not 
quite  equal  to  the  ipecacuanha  spray. 

Turkish  b.\th,  58. 

Turpentine,  306.     Small  doses  as  a  diuretic. 

OR  terebine,  304.     As  inhalation. 

Zinc,  oxide  of,  210.  For  profuse  bronchial 
secretion. 

,  ,suLPH.\TE  of,  209.  As  emetic  ;  others  gen- 
erally preferred. 


BRONCHOCELE.     {See  Goitre.) 


BRUISES. 

Capsicum,  315.  A  strong  tincture  applied  with 
gum  said  to  act  like  a  charm  on  discolored 
bruises. 

Hamamelis,  252.     On  lint  or  cotton  wool. 

Sulphurous  acid,  131.  A  solution  constantly 
applied. 


BUBO. 

Iodine,  102.   Applied  to  produce  vesication  round 

a  bubo  relieves  the  inflammation. 
Nitric  acid,  123.    To  indolent  and  broken  bubo. 
Sulphides,  95.     Less  useful  in  maturating  than 

in  the  case  of  ordinary  boils  or  abscesses. 


BURNS. 

BoRACic  ACID,  133.     As  ointment. 

Carbolic  acid,  257,    A  one  per  cent,  solution  on 

lint  frequently  renewed  relieves  pain. 
Cocaine,  440.     As  lotion   painted   on  scalds  to 

relieve  pain. 
Collodion,   236.      Painted    over    slight    burns 

subdues  inflammation. 
Lime,  152.     As  lime-water  and  oil. 
P.ARAFFIN,  133. 
Soda,  136.    A  saturated  solution  of  the  carbonate 

locally  for  burns  and  scalds. 
Warm  b.\th,  52.     Immerse  for  some  days. 


CALCULI. 

Alkalies,   145.      To  dissolve   uric   acid  calculi 

(renal  or  vesical). 
Citrate    of    pot-^sh,   144.     In   large   doses   for 

patients  with  bloody  urine  containing  quantities 

of  uric  acid  crystals. 
Counter-irrit.-\nts,   83.       Relieve     pain     from 

passage  of  renal  and  biliary  calculi. 
Nitric  acid,  130.     Very  dilute  as  injection  for 

phosphatic  calculi. 


CANCER.    {See also  Stomach  and  Uterus.') 

Arsenic,  215.  Arsenious  acid,  pure  or  with 
starch,  as  a  caustic — enough  should  be  used  to 
set  up  the  active  inflammation  (see  ref.). 

,  231.  A  long-continued  course  recom- 
mended in  epithelioma,  scirrhus,  and  rodent 
ulcer. 


CANCER — contimied. 

Carbolic  acid,  257.  Pure,  as  ansesthetic  before 
applying  caustics. 

Carbo.nic  acid,  88.  Injected  up  vagina  in  can- 
cer of  uterus  to  relieve  pain. 

Chloral,  285.  In  ten  gr.  doses  three  times  a 
day,  has  relieved  most  severe  pain  of  cancer. 

Chloroform,  269.  As  vapor  to  raw,  painful 
surface. 

CoNiUM,  362.     As  poultice  to  ease  pain. 

■ — ,  364.     Internally  to  relieve  pain. 

Creasote,  255.     Has  been  employed. 

Glycerine  of  carbolic  acid,  247.  As  applica- 
tion to  foetid  cancers  on  surface  or  in  uterus. 

Glycerine  of  tannin,  247.  With  glycerine  of 
carbolic  acid  checks  discharge  and  stench  of 
uterine  cancer. 

Iodofor.m,  279.  Applied  locally  relieves  the  pain 
of  cancerous  sores. 

Morphia,  406.  Dissolved  in  glycerine  and  spread 
on  lint,  very  useful  where  there  is  much  pain. 
Opium  is  also  used  in  cancer  of  the  stomach. 

Opium,  406.     To  cancerous  sores. 

Poultices,  65.     Of  starch  applied  cold. 

Warm  enem.^ta,  76.  To  relieve  pain  and  strain- 
ing in  intestinal  cancer. 


CANCRUM  LABIALIS  AND  ORIS. 

Arsenic,  216.     In  cancrum  oris. 
Nitric  acid,  123.     To  surface. 


CANKERY  TASTE. 

Mercury,  334.     If  podophyllin  fail. 
Podophyllin,    334.       When   unconnected    with 

alcoholism. 
Purgatives,    334.       Mercury    and    podophyllin 

generally  best. 
Water,  73.     Half  a  tumbler  of  pure  cold  water 

daily  half  an  hour  before  breakfast. 


CARBUNCLE. 

Arnica,  237.  Ointment  on  plaster,  also  inter- 
nally. 

Belladonn.\,  96.  With  glycerine  as  local  appli- 
cation to  allay  pain. 

Carbolic  acid,  258.  Lint  soaked  in  glycerine 
or  oil  and  carbolic  acid  to  be  thrust  into  dis- 
charging sinuses,  the  whole  to  be  covered  over 
with  more  lint  similarly  prepared. 

Iodine,  84.  Applied  so  as  to  produce  vesication 
round  the  carbuncle,  reduces  inflammation. 

Me.nthol,  solution  of,  307. 

Opium,  408.  An  extract  of  the  consistence  of 
treacle  applied  three  or  four  times  a  day  (see 
ref.) 

Poultices,  63.  The  inflamed  surface  having 
been  previously  smeared  with  belladonna  and 
glycerine. 

Strapping,  236.  Plaster  concentrically  from 
border  inwards,  will  sometimes  arrest  extension. 

Sulphides,  95. 


CARDIAC   DROPSY.      {See  Heart  Dis- 
eases and  Dropsies. ) 

CARIES. 

Phosphate  of  lime,  156. 

C AT .-V R R H .      {See  also  Bronchitis.) 

Aconite,  341,  343.     In  catarrh  of  children  and  in 
measles. 


488 


INDEX    TO    DISEASES. 


CATARRH — continued. 

AcT.'EA  RACEMOSA,  338.  Has  been  given,  it  is 
said,  with  much  success,  when  headache,  stiff- 
ness of  muscles,  and  dull  aching  pain  in  bones. 

Antimony,  214.  As  tartar-emetic  in  acute  catarrh 
of  children,  which  is  often  accompanied  by 
vomiting  and  diarrhoea. 

Chlor.ate  of  potash,  168.  Should  be  taken 
early  and  frequently,  eight  or  ten  lozenges  in 
the  twenty-four  hours. 

Chloride  of  a.mmonium,  i5g.  In  chronic  catarrhs 
of  bronchial  and  urinary  mucous  membrane 
when  secretion  thick  and  abundant. 

CuBEBS,  308.  3  ss.  to  3  j.  of  the  tinct.  in  linseed 
tea  thrice  daily.  Very  useful  in  coughs  due  to 
chronic  catarrh,  or  those  following  influenza, 
or  a  simple  acute  catarrh,  or  occurring  in  em- 
physematous patients. 

EucALVPTOL,  309.  In  chronic  bronchial  catarrh 
and  bronchorrhoea. 

Hamamelis,  252.  Snuffed  up  nose  in  colds  of 
the  head  and  catarrh  of  mucous  membrane. 

Hot  spoNcrNG,  52.     For  headache. 

Iodide  of  potassium,  109.  Five  grs.  of,  %  gr. 
tartar  emetic,  i  oz.  syrup  of  orange  peel,  3  ozs. 
of  water  in  teaspoonful  hourly  doses  for  acute 
febrile  catarrh,  specially  for  children. 

Iodine,  100.  Painted  over  back — front  in  chronic 
bronchial. 

Iodoform,  280.     In  spirits  of  turpentine. 

Ipecacuanha,  317.  In  catarrh  of  stomach  or 
lungs,  especially  when  secretion  from  lungs 
abundant  and  tenacious. 

Lamp  b.\th,  61. 

Opiim,  409.'  Or  morphia  may  be  given  when 
there  is  violent  and  frequent  cough  but  no  signs 
of  obstructed  o.xidation. 

Sulphides,  94.  As  natural  waters  highly  effica- 
cious in  chronic  catarrh  of  the  pharynx. 

Turkish  bath,  59.     la  chronic  catarrh. 

Warm  foot-bath,  52.     Before  going  to  bed. 


CATCH  IN  THE  BREATH. 

Cold  sponging,  55.     For  infants  waking  with  a 
catch  in  the  breath  at  night. 


CEPHALALGIA.     {See  Headache.) 


CHANCRE.     {See  Syphilis.) 

Caustic  alkalies,  134.     To  hard  edges. 
Eucalvptol,   309.      With  iodoform  applied  to 

both  kinds  of  sores. 
Iodoform,  279.     Dusted  over  soft  chancres. 
lODOL,  281. 
Nitric  acid,  123.     To  soft  chancres. 


CHANGE  OF  LIFE. 

AcT.tA,  338.     For  headache. 

Ammoni.\,  147.  As  Raspail's  sedative  lotion  to 
be  applied  to  the  painful  part  of  the  head  in 
the  headaches  of  this  period. 

Bromide  of  potassium,  117.  For  despondency 
with  sleeplessness  and  irritability,  often  also 
with  heats,  flushings  and  perspirations. 

Calabar  BEAN,  367.     For  flatulence. 

Camphor,  302.  For  drowsiness  and  headache, 
eau  de  Cologne  saturated  with  camphor  to  be 
rubbed  into  the  head. 

Change  OF  air  and  scene,  118.  Where  other 
treatment  only  partially  successful. 

Euc.\lvptol,  309.  For  various  symptoms,  as 
palpitations,  flushings,  flatulence. 

Hot  SPONGING,  58.  To  spine,  following  by  appli- 
cation of  cold  sponge. 


CHANGE  OF  'LIYY.— continued. 

Iro.v,  118.     For  flutterings  of  the  heart. 

,  177.     Large   doses  of  sesquichloride   three 

times  a  day  in  fluttering  of  heart  with  fullness 
of  head,  heat,  and  weight  on  the  vertex,  fre- 
quent flushings  and  hot  and  cold  perspirations. 
If  symptoms  limited  to  head  and  face,  nux 
vomica,  opium  and  belladonna  more  successful. 

Nitrite  of  amvl,  297.  In  small  doses  when  the 
heats  predominate. 

Valeri.\nate  of  zinc,  210.  For  hysterical  symp- 
toms. 

Vinegar  and  water  sponging,  58.  Every 
morning  to  spine. 

War.m  bath,  52.     Once  a  week. 


CHAPS.     {See  Nipples,  Sore.) 

Collodion,  236.  Sometimes  used,  but  for 
chapped  hands  and  lips  glycerine  of  starch, 
arnica  cerate  or  eau  de  Cologne  and  glycerine 
better  ;  for  chapped  nipples  sulphurous  acid 
and  glycerine. 

Glycerine,  247.  Or,  better  still,  glycerine  of 
starch. 

Sulphurous  acid,  131.  As  solution  or  fumiga- 
tion. 

V.aseline  and  petroleum,  253. 


CHEST,  PAINS  IN,  NON-INFLAM- 
MATORY. (.S-^-^  Myalgia  and 
Pleurodynia.) 

Belladonna,  ioi.     When  tenderness  is  in  skin, 

pleurodynia. 
Iodine,  ioi.      As  ointment  in  muscular  pains, 

myalgia. 


CHILBLAINS. 

Balsam  of  Peru,  306.  In  ointment  for  broken 
chilblains. 

C.ajeput  oil,  306.     Locally. 

Capsicum,  315.  The  tincture  painted  over  un- 
broken chilblains,  but  this  is  inferior  to  iodine. 
For  De  Rheims's  preparation  (see  ref.) 

Iodine,  ioi.     Ointment  is  best. 

Sulphurous  acid,  131.  As  solution  or  fumiga- 
tion. 


CHLOASMA.   {See  Pityriasis  Versicolor.) 


CHLOROSIS. 

Hvpophosphites,  158.     Of  lime  or  soda. 
Iron  salts,  175.     When  flabby  tongue. 


CHOKING. 

Bromide  of  potassium,  115.     In  children  who 
choke  with  liquids  from  their  birth  (see  ref.) 


CHOLERA  AND  CHOLERAIC  DIAR- 
RHCEA. 

Arsenic,  222.     Has  been  recommended  for  the 

vomiting  of  cholera  and  in  collapse  in'he  later 

stages. 
Camphor,  302.     Four  to  six  drops  of  the  strong 

spirit   of  camphor  every   ten    minutes  at  the 

commencement  till   the  symptoms  abate,  and 

hourly  afterwards. 

-An  admirable  remedy  for  summer  diarrhoea 

and  cholera. 
Chloral,   284.        Hypodermically    in    cholera. 

May  be  combined  with  morphia. 


INDEX    TO    DISEASES. 


489 


CHOLERA,   'E.TC— continued. 

Copper,  207.     The  salts  have  been  given. 

Lead,  183.  The  acetate  has  been  recommended 
in  early  stages. 

Mercury,  201.  A  si.\th  of  a  gjain  of  gray  pow- 
der hourly  is  of  great  service  in  infantile  cholera 
with  incessant  sickness,  profuse  almost  con- 
tinuous diarrhoea,  offensive  and  nearly  colorless 
stools.  A  starch  injection  with  a  minute 
quantity  of  laudanum  assists  the  gray  powder, 
and  should  be  given  in  urgent  cases. 

Morphia,  408.  One-eighth  to  one-fourth  of  a 
grain  hypodermically  of  the  greatest  value  even 
in  the  stage  of  collapse. 

Spinal  ice-bag,  71.    For  cramps. 


CHORDEE. 

Aconite,  345.     In  drop  doses  hourly.      Said  to 

remove  chordee. 
Camphor,  303. 
Cantharides,  313.     A  drop  of  the  tincture  three 

times  a  day. 


CHOREA. 

AcT^A  RACEMOSA,  337.  Sometimes  succeeds 
when  rheumatic  history. — Inferior  to  arsenic. 

Antimony,  214.  As  tartar-emetic  in  increasing 
doses  ;  other  remedies  better. 

Apomorphi.\,  327. 

Arsenic,  230.  When  uncomplicated  very  suc- 
cessful. 

Calabar  bean,  366.  Three  to  six  grains  of  the 
powder  three  or  four  times  a  day  for  children, 
or  ten  to  twenty  grs.  for  adults. 

Chlor.\l,  284.  Sometimes  useful,  especially 
where  the  violent  movements  render  sleep  im- 
practicable. 

Chloroform,  276.  Inhalations, — commence  with 
them  three  times  a  day,  often  of  great  service 
in  severe  cases. 

Cod  liver  oil,  243. 

Cold  sponging,  55.  Not  if  rheumatism,  fever, 
or  pain  in  joints.  Often  well  to  use  water  tepid 
first. 

CoNiUM,  364.     Apparently  only  palliative. 

Ether  spray,  278.     Has  been  recommended. 

Hyoscyamia,  401.  i-50th  gr.  hypodermically  or 
by  stomach. 

Morphia,  407.  Hypodermically  when  the  move- 
ments prevent  sleep. 

Silver,  190.  Both  the  o.xide  and  nitrate  occa- 
sionally useful. 

Spin.\l  ice-bag,  71. 

Sulphate  of  zinc,  209.  In  large  and  increasing 
doses.     (See  ref.) 

Valerian,  310.  The  preparations  are  said  some- 
times to  restrain  the  movements  of  chorea. 

Veratrum  viride,  328.     Has  been  employed. 


CLAVUS. 

Chloride  of  ammonium,  159. 

COLD  FEET. 

Sponging,  58.     With  vinegar  and  water,  or  first 
with  hot  then  with  cold  water. 

COLD,  FEVERISH. 

Turkish  bath,  59.     At  commencement  will  cut 
short,  also  useful  later  on. 

COLD   IN   HEAD.     {See  Coryza.) 


COLDNESS. 

Cold  water,  58.  Cold  feet  should  be  immersed 
in  cold  water  nightly  for  a  few  minutes,  rub- 
bing them  all  the  time,  they  should  then  be 
dried  and  warm  woolen   socks  put  on. 

Spinal  ice-bag,  71.     For  cold  feet. 

Strychnia,  424.    For  coldness  of  hands  and  feet. 


COLDS,  TENDENCY  TO  CATCH. 

Cold  sponge  bath,  59.     Supplemented  by  wet- 
sheet  packs,  or  Turkish  bath. 


COLIC. 

Alum,  171.  Large  doses  (ten  grs.)  every  hour 
given  by  many  in  lead  colic. 

Ammonia,  148.  In  spasm  of  intestinal  canal  and 
in  colic  of  children  or  infants  from  bad  feeding. 

Belladonna,  389.  In  colic  of  intestines,  es- 
pecially of  children. 

Bro.mide  of  pot.^ssium,  115.  In  a  peculiar  form 
in  young  children.     (See  ref.) 

Chloral,  285.     Sometimes  relieves. 

Chloroform,  270,  276.  Inhalation  in  renal  and 
biliary  colic,  inferior  only  to  morphia  injection, 
superior  to  opium,  warm  baths,  &c.,  two  or 
three  administrations  may  be  required. 

,  277.     lll,v-lx.  every  4  or  6  hours  in 

biliary  colic  said  to  dissolve  calculus. 

,  SPIRIT  OF,  270.     In  all  colics,  often 

combined  with  opium. 

Counter-irritation,  83.  For  renal  and  biliary 
calculi. 

Essential  oils,  307.  Especially  of  cloves  and 
cinnamon. 

Ether,  278.     For  biliary  or  intestinal  colic. 

Fo.mentations,  62.     In  all  forms. 

Lime-water,  153.  For  young  children  who  eject 
much  of  their  milk  in  lumpy  masses,  some  of 
these  lumps  passing  through  the  intestines 
causing  colic  and  wind. 

Opium,  411.  Or  morphia  in  frequently  repeated 
small  doses  for  colic  of  intestines.  Where,  as 
is  usual,  there  is  constipation  a  purgative  should 
be  given. 

,  416.  Small  doses  with  spirit  of  chloro- 
form every  five  or  ten  minutes  till  the  pain 
gives  way  in  renal  or  biliary  colic,  or  morphia 
hypodermically. 

Phosphate  of  sod.\,  164.  In  hepatic  coHc  to 
prevent  formation  of  gall-stones — must  be  con- 
tinued for  months. 

TtHiACCO,  360.  As  clyster  or  by  the  stomach  in 
colic  of  intestines. 

Turpentine,  306.  Has  been  given  with  advan- 
tage in  biliary  colic. 

Warm  bath,  51,  To  ease  pain  in  biliary,  renal, 
or  other  colic. 


COMA. 

Bitartrate  OF  potash,  Sulphate  of  soda,  and 
Tartrate  of  soda,  163.  As  purgatives  when 
blood  poisoned. 

Blisters,  81.  In  a  comatose  condition  large 
blisters^r  mustard  poultices  should  be  applied 
in  quiot  succession  to  different  parts  of  the 
body — chest,  abdomen,  thighs,  and  calves — 
often  very  valuable  in  the  critical  condition 
near  the  end  of  an  acute  illness. 

Cold  douche,  56.  For  stupor  of  drunkenness 
or  of  opium  poisoning.  Alay  have  to  be  re- 
peated if  relapses  occur.  It  should  be  kept  up 
for  a  long  time  if  pulse  and  breathing  improve 
or  even  become  no  worse. 

Croton  oil,  246.  A  purgative- -one-quarter  or 
one-third  mm.  every  hour. 


490 


INDEX    TO    DISEASES. 


CONDYLOMATA. 

Arsenic,  215.     Arsenious  acid  as  a  caustic.    (See 

ref.) 
Mercury,  191.     The  nitrate  locally. 

,  194.     Oleate  (20  per  cent.). 

1  196.     Calomel  dusted  over. 

Nitric  acid,  123.     As  a  dilute  wash  constantly 
p  applied. 

Zinc,  208.     Chloride,  iodide,  and  nitrate  locally. 

CONFINEMENT.  (See      Puerperal 

Fever. ) 

ACT.EA   RACEMOSA,    337.      Strengthens   contrac- 
tions  of   uterus   without   prolonging   them   as 

ergot  does,  and  so  endangers  less  life  of  child 

and   soft    structures   of    mother.      Sometimes 

given  for  after-pains,  but  ergot  preferable  here. 
Beneficial  in    mental   disturbance   before   or 

after  confinement,  3:17. 

Useful  when  lochia  are  suppressed. 
Castor  oil,  246.     As  purgative  afterwards. 
Chloral,  284.     In  fifteen  gr.  doses  every  quarter 

of  an  hour  till  sleep  induced — applicable  towards 

termination  of  first  stage. 
Chloroform,  275. 
Cold  douche,  56.     In  insomnia. 
Emetics,    326.        Or    mechanical    irritation     of 

pharyn.x  in  flooding. 
Ergot,  431.      In  tedious  labor  where  uterus  is 

becoming    exhausted,  but   where    there  is   no 

obstruction  to  the  passage  of  the  child.     (See 

ref.). 

Extremely   useful    in  post-J>artum   ha;mor- 

rhage. 
Hamamelis,  252.     For  long-continued  oozing  of 

blood  afterwards. 
Ipecacuanha,   326.       In    flooding— also  recom- 
mended   after    delivery    to    promote    natural 

functions. 
Iron,    178.      Injection  of    four  ozs.  of  liq.   ferr. 

perchlor.  with  twelve  ozs.  water  in  grave  cases 

of  flooding  after  delivery— care  to  be  taken  not 

to  introduce  air. 
Morphia,  408.     Hypodermically  in  tedious  labor 

produced  by  rigid  os  uteri. 
Opium,  418.     A  drachm  of  the  tinct.  with  brandy 

in  profuse  flooding. 
QuiNiA,  447.     To  strengthen  uterine  contractions 

— used  by  some  American  writers  in  preference 

to  ergot. 

CONJUNCTIVITIS.       {See   Eyes,    Dis- 
eases of.) 

Belladonna,  388.     Locally  and  internally. 

Blisters,  84.     Behind  the  ear. 

Castor  oil,  246.     A  drop  in  the  eye  often  allays 

pain   and   intolerance   of  light   caused   by   an 

irritant. 
Mercury  and  morphia,  oleate  of,  194.  Outside 

the  eyelid  in  palpebral  conjunctivitis. 
Opium,  409.    The  wine  of  the  1864  Pharmacopoeia 

dropped  into  the  eye  relieves  pain  and  improves 
^  condition  of  the  membrane. 
Silver,  nitrate  of,  189.      Solutions  of  various 

strength  dropped  into  the  eye. 
Zinc,  208.     A  weak  solution  of  sulphate  as  drops. 

CONSTIPATION. 

Aloes,  458.     In  chronic  cases.     Often  combined 

with  iron.  ♦ 

Belladonna,  388.     One-sixth  to  one-fourth  of  a 

grain  of  the  extract  once  a  day,  especially  when 

dyspepsia.      Sometimes  a  suppository  of  one  or 

two  grs.  efificacious  in  severe  cases. 
Bitari  rate  of  potash.  Sulphate  of  magnesia, 

and  Phosphate  of  soda,  164.       In  broth  for 

children. 
Carlsbad  water,  162.     In  habitual  constipation 

—best  to  use  a  system  as  at  Carlsbad.    (See  ref.) 
Cascara  sagrada.  462. 


CONSTIPATION— f^«//««,'rt'. 

Castor  oil,  246.  A  speedy,  certain,  and  mild 
purgative.  Not  good  for  habitual  constipation. 
3  ss.  of  the  oil  if  rubbed  up  with.  3  ss.  glycerine 
a  sufficient  dose. 

Cop  LIVER  oil,  243.  In  the  obstinate  constipa- 
tion of  children. 

Coffee,  432.  Is  slightly  purgative  in  some  per- 
sons. 

Colocvnth,  457.  A  few  drops  of  the  Prussian 
tincture  several  times  a  day  in  obstinate  con- 
stipation. 

Croton  oil,  246.  A  very  powerful  purgative, 
sometimes  employed  in  obstinate  constipation 
where  other  purgatives  fail. 

Diet,  162.  Porridge,  brown  bread  and  exercise 
when  busy,  worried  men  become  irritable  and 
suffer  from  headache,  unless  the  bowls  act 
every  day.  If  these  remedies  fail,  try  fruit  be- 
fore or  after  breakfast,  or  natural  purgative 
waters. 

Enemata,  75,  76.  To  unload  the  bowels,  but  the 
habitual  use  of  warm  enemata  will  increase  the 
torpor  of  the  bowels. 

Glycerine,  248.     As  an  anal  injection. 

Guaiacum,  336.     Obstinate  constipation. 

Ipecacuanha,  320.  A  grain  every  morning  fast- 
ing for  constipation  from  great  torpor  of  intes- 
tines. It  is  said  to  assist  the  action  of  the  other 
purgatives. 

Jalap,  460.  And  scammony  in  obstinate  con- 
stipation. 

Kneading  of  the  abdomen,  76.  Night  and 
morning  for  10  minutes  often  overcomes  chronic 
constipation,  especially  in  children. 

Lime,  154.  As  saccharated  solution— this  must 
not  be  taken  on  an  empty  stomach. 

Magnesia,  bicarbonate  of,  151,  i.e.,  fluid  mag- 
nesia. A  useful  and  mild  aperient.  Often 
combined  with  rhubarb. 

Mercury,  i,  2.  Calomel,  or  gray  powder,  as  a 
purgative,  especially  if  stools  light.  Nitric 
acid  and  nux  vomica  assist  its  etlicacy.  (But 
see  p.  199.) 

Natural  waters,  61.  Pullna,  Friedrichshall,or 
Hunyadi— fromawineglassfulto  half  a  tumbler 
or  more,  with  an  equal  quantity  of  hot  water 
before  breakfast. 

PuUna  or  Friedrichshall  mixed  with  milk  a 
good  purgative  for  children. 

Ntat- Vowte^t,  421.  The  extr.  with  rhubarb  or 
colocynth  shortly  before  dinner,  aids  digestion 
and  the  unloading  of  the  bowels.  One  or  two 
drops  of  this  tinct.  two  or  three  times  a  day  will 
do  instead. 

Oranges,  161.  One  or  two  before  breakfast  for 
moderate  habi'ual  constipation,  or  a  glass  of 
cold  water  before  and  an  orange  .soon  after 
breakfast. 

Podophyllum,  334.  One  or  two  drops  two  or 
three  times  a  day  of  the  solution  of  one  grain  of 
the  resin  in  one  drachm  of  alcohol  for  children 
with  hard,  clayey,  perhaps  mottled  stools 
occurring  after  an  attack  of  diarrhoea  (often 
observed  in  infants  who  are  spoon-fed).  Gen- 
erally the  best  purge  when  stools  are  dark. 
Nitric  acid  and  nux  vomica  should  be  given 
simultaneously. 

For   remarks  on   indications  of   the   tongue, 
see  p.  I. 

Rhubarb,  462.  A  useful  purgative  for  children, 
especially  when  mixed  with  two  or  three  times 
its  weight  of  carbonate  of  soda. 

Senna,  462.  Well  combined  with  a  bitter  tonic, 
as  gentian. 

Senna  leaves,  75.  Steeped  first  in  hot  then  in 
cold  water,  an  excellent  evacuant. 

Sitz-bath,  58.  Cold  or  tepid,  followed  by  fric- 
tion with  rough  towel. 

Soap,  nq.  Added  to  anal  injections  to  suspend 
castor  oil  or  turpentine,  or  a  piece  the  size  of 
the  thumb  whetted  with  castor  oil  or  water 
may  be  thrust  up  the  rectum  to  produce  a 
motion,  especially  in  infants  and  children. 


INDEX    TO    DISEASES. 


491 


CONSTIPATION— f^«//««ev/. 

Sl'LPHATES,  164,  165.  In  purgative  natural  waters 
—small  doses  often  repeated.  Sulphate  of 
potash  has  in  some  cases  proved  poisonous. 

SiLi'HLR,  91.  Ten  grs.  with  conf.  sennje,  or  as 
the  German  comp.  liquorice  powder  in  milk — 
the  latter  good  for  children. 

Tobacco,  36-^.  A  smoke  after  breakfast  some- 
times beneficial  in  habitual  constipation. 

Whole-meal  bkead,  476.     See  Dietary. 


CONVALESCENCE. 

Alcohol,  262.  Before  or  at  meals. 
Fats,  241.  Especially  cod-liver  oil. 
Lime,  154.     As  lime-water  or  carbonate  of  lime, 

in  convalescence  from  serious  diseases. 
Oi'iTM,   411.       As   laudanum    injected   into   the 

rectum  for  the  wakefulness  of  convalescents. 
Sea-uaihs,  38. 


CONVULSIONS. 

Bitartrate  of  potash.  Sulphate  of  soda,  and 

Tartrate  of  potash,  i  3.    When  due  to  poi- 

soned'blood. 
Bromide  of  potassium,  115.     In  all  forms. 
Chloral,  2S4.     In  children— five  grs.  by  mouth 

or  rectum. 
Chloroform,  276.     Inhalations  of  great  service 

in  children,  also  in  puerperal  convulsions. 
Ice,  68.     To  head. 
MorphL'V,  408.   Hypodermically  sometimes  arrests 

puerperal  convulsions. 
Spinal  ice  bag,  71.     In  infantile  convulsions. 
Veratrum  viride,  328.     Has  been  employed. 


CORNS. 

Salicylic  acid,  452. 


(For  formula  see  ref.) 


CORYZA  AND   HAY  FEVER. 

Aconite,  341.  In  severe  colds  with  much  chilli- 
ness, aching  of  limbs,  a  hot  dry  skin  and  a  quick 
pulse. 

,  221.     In  true  hay  fever. 

Ammonia,  148.  Inhalation  in  early  stage. 
Arsenic,  220,  221.  In  chronic  coryza.  Also  in  peri- 
odical attacks  of  persistent  sneezing,  with 
coryza,  frontal  headache,  and  often  an  itching 
of  the  nostrils  ;  sore  throat,  wheezing,  and  pro- 
fuse expectoration  may  supervene.  Often  this 
affection,  allied  to  peptic  asthma,  may  be 
brought  on  by  food  or  by  irritation  of  dust  or 
pollen.  Aconite  liniment  may  be  applied  to  the 
Itching  part  of  the  nose. 

Arsenic  of  little  use  in  true  hay  fever,  then 
aconite  internally  best.     (See  ref. ) 
Camphor,  301.     Inhaled  or  taken  by   the  mouth 

at  the  very  beginning  sometimes  arrests  it. 
Carbolic  spray,  258.      To  nose  in   contagious 

coryza. 
Chlor.\te  of  potash,   168.     Eight  or  ten  lozen- 
ges a  day  will  stop  many  a  cold  at  its  com- 
mencement. 
Cocaine,  439.    Solution  for  painting  nasal  mucous 

memb.,  also  for  arrest  of  acute  coryza. 
Glycerine,  248.     Vaseline  preferable. 
Ha.mamelis,  252.     Snuffed  up  nose  in  colds  and 

hay  fever. 
Iodide  of  potassium,  109.     Ten  grains  at  bed- 
time at  onset  to  cut  short  acute  cold  in  head  ; 
also  useful  in  chronic  colds. 
Iodine,  103.     Inhalation  in  daily  attacks  of  cold 
accompanied  by  itching  of  nose  or  inner  can- 
thus. 
Ipecacuanh.\,  324.    In  hay  asthma. 
Opium,  417.     At  night  at  the  very  beginning  will 
often  cut  short  an  attack  of  coryza.    A  glass  of 
hot  grog  assists  its  action. 


CORYVA,   'Eic.—continufJ. 

Piece  of  cotton-wool,  307.  Saturated  with 
menthol  placed  in  each  nostril  directly  sneezing 
and  itching  commence. 

Quinia,  442.     Strong  solutions  to  flush  nose. 

Sulphurous  acid,  131.  Inhalation,  spray  or 
fumigation  in  coryza. 

Turkish  bath,  59.     In  coryza. 

Veratrum  viride,  328.     If  arsenic  unsuccessful. 


COUGH. 

Alcohol,  268.    As  brandy  or  wine.     Porter  and 

beer  often  aggravate  coughs. 
Alum,  171.     '1  en  grs.  to  one  drachm  of  water  as 
spray  in  chronic  cough  ;  also  internally  in  spas- 
modic coughs. 
Belladonna,   393.     Often  useful — no  rules  can 

be  given. 
Carbonic  acid  gas,  88.     As  inhalation  in  irrita- 
ble cough. 
Chloroform,  270,  271.    With  morphia  and  treacle 
when  cough  paroxysmal  and  violent  with  very 
slight  expectoration  ;  when  it  arises  from  morbid 
condition  of  throat  this  mixture  may  be  painted 
on. 
Cod-liver  oil,  243.     In  chronic  coughs. 
CoNiUM,  364.     Supposed  useful  in  whooping  and 
ther  coughs. 
Inhalation  for  irritable  cough. 
Creasote,  255.     In  winter  cough. 
Cubebs,  308.      3  ss.  to  3  j.  of  tinct.  in  linseed  tea 
in  acute  or  chronic  catarrh,  influenza,  or  em- 
physema— often  acts  "  like  a  charm." 
Gelsemiu.m,  379.     When  excessive  excitability  of 
respiratory     centre— ether,     chloroform,    and 
opium  also  useful. 
Glycerine,  247,  248.  Lemon-juice  may  be  added. 
Glycerine   of   tannin,  250.     As  application  to 
the  throat  when  chronically  inflamed  and   so 
productive  of  cough,  which  is  often  the  case  in 
children. 
Hydrocyanic  acid,  405.     For  irritable  coughs. 
Iodine,  103.    Inhalation  for  children  with  hoarse, 
hollow  cough,  accompanied  by  hoarseness  and 
wheezing  at  the  chest. 
Iodoform,  280.     Cough  of  phthisis  diminishes. 
Ipecacuanha,  321.      In  obstinate  winter  cough 
with  wheezing  the  wine  applied  as  spray  to  the 
fauces  is  very  efficacious. 
Opium,  409.     When   cough   due   to   inflamed   or 
even   ulcerated  throat.      Morphia  lozenges  or 
morphia  with  glycerine  in  these  cases,  which 
are  common  in  chronic  phthisis,  very  useful, 
409.    Sometimes  also  opium  and  morphia  admin- 
istered so  that  the  medicine  clings  for  some  time 
in    contact   with    structures  just    outside   the 
larynx  effectual  in  coughs  entirely  dependent 
on  lung  disease. 
Tar,   255.      In   winter  cough,    especially   when 

paroxysmal. 
Turkish  bath,  59.     In  winter  cough. 


CRACKED 

Sore.) 


NIPPLE.         {See   Nipples, 


CRICK  IN  THE  NECK. 


CROUP. 

Aconite,  341.  Valuable  in  catarrhal  croup  (spas- 
modic laryngitis). 

Alum,  171.  One  drachm  in  honey  or  syrup  every 
ten  or  fifteen  minutes  till  vomiting  induced.  In 
severe  cases  vomiting  should  be  caused  three  or 
four  times  a  day,  treatment  to  be  begun  ear'y- 

Copper,  Sulphate  of,  207.  In  small  and  fre- 
quent doses  as  a  vomit. 

Lobelia,  427.     Has  been  employed. 


492 


INDEX    TO    DISEASES. 


CRO\3V— continued. 

Senega,  463.     Given  by  some. 

Sulphurous  acid,  131.     Spray  hourly  or  oftener 

in  acute  attack. 
Tannin,  250.     A  spray  containing  5  per  cent,  of 

tannin  several  times  a  day  for  fifteen  or  twenty 

minutes. 
Zinc,  sulphate  of,  209.     As  emetic,  but  others 

generally  preferred. 


CYSTITIS. 

Alkalies,  144.  Citrates  and  bicarbonates  used 
to  make  urine  alkalme,  when  urinary  organs 
irritated  or  inflamed.  When  urine  already 
alkaline,  alkalies  must  be  intermitted. 

BucHU,  308.  Also  copaiba  and  cubebs  in  chronic 
inflammation  of  bladder  and  urethra. 

C.antharides,  312.  A  drop  of  the  tincture  (five 
sometimes  required)  three  times  a  day. 

Carbolic  acid,  258.  And  sulpho-carbolates 
may  possibly  be  used  in  preserving  the  urine 
sweet  in  cystitis. 

Euc.\LYPTOL,  309. 

Hot  enemat.^,  76.     To  relieve  pain. 

Hot  sitz-b.'\th,  52.  Allays  pain  and  incessant 
desire  to  micturate. 

Iodoform,  279.  A  suppository  for  painful  dis- 
eases of  rectum  and  bladder. 

Opium,  411.  An  injection  of  laudanum  with 
starch  will  subdue  pain  and  frequent  micturi- 
tion. 

Pareira,  308.     In  chronic  cystitis. 

Turpentine,  306.  Has  been  useful  in  chronic 
cystitis. 


DANDRIFF.      {See  Pityriasis  of  Scalp.) 

Borax,  135.  Head  to  be  sponged  several  times 
a  day  with  a  saturated  solution,  or  the  glycerine 
of  borax  may  be  used. 

Tannic  acid,  glycerine,  lard,  bals.\m  of  peru, 
and  OIL  of  bitter  al.monds,  249. 


DEAFNESS.      {See  Ears,  Diseases  of.) 

Glycerine,  247.  For  dryness  of  meatus — also 
to  form  a  film  to  cover  ruptured  tympanum. 

Glycerine  of  tannin,  250.  As  application  for 
throat  deafness. 


DEBILITY. 

Alcohol,  3.  In  aged  patients  with  dry  tongue 
great  care  must  be  exercised  and  alcohol  given 
in  small  quantities,  the  effect  on  the  dryness  of 
the  tongue  being  carefully  watched. 

■ ,  265.  A  wine  with  much  ether  in  de- 
bility of  old  age,  especially  where  sleeplessness, 
indigestion  and  stomach  cramps. 

,  268.  Stout  or  rum  and  milk,  especi- 
ally in  town-living  women. 

Arsenic,  226.  For  swelled  feet  of  old  or  weakly 
persons  and  for  breathlessness  from  weakly  act- 
ing heart. 

Cod-liver  oil,  241.  In  chronic  degenerative 
diseases  of  old  age. 

,  243.  In  chronic  diseases  of  chil- 
dren. 

Hvpophosphites,  158.  Of  lime  or  soda  in  ner\-- 
ous  or  general  debility. 

Iron,  173,  <S:c.     In  anaemic  subj 

Morphia,  415.  Hypodermically  when  due  to  on- 
anism, and  in  great  hysterical  depression. 

Phosphate  of  lime,  156.  When  from  prolonged 
town  life  or  overwork,  a  grain  each  of  phosphate 
o{  lime,  phosphate  of  iron  and  carbonate  of  lime 
for  a  dose. 


DY.m'LlTY— continued. 

Quinia,  448.  For  pale,  badly  fed  town-dwellers. 
Sea-bathi.ng.  38.  In  chronic  illness  with  debility. 
Soporifics,  3.     In  aged  patients  if  tongue  is  dry 

great  caution  must  be  exercised. 
Turkish    baths,  59,  60.     When  caused  by    the 

tropics—caution  necessary.  When  town-dwellers 

become  stout  and  flabby. 


DELIRIUM. 

Antimony',  214.  In  delirium  of  typhus  and  other 
fevers.     (See  fevers.) 

Bell.'VDONN.'v,  394.  In  delirium  of  typhus  and 
other  fevers. 

Bromide  of  potassiu.m,  119.  In  delirium  re- 
sembling delirium  tremens,  also  in  acute  m<inia. 

Camphor,  303.     In  large  doses. 

Chloral,  282.     In  violent  delirium  of  fevers. 

Cold  douche,  57.  In  maniacal  delirium— place 
patient  in  warm  bath  during  the  application. 

Opium,  411.  Best  given  in  traumatic  delirium  as 
a  rectal  injection. 

,   414.      Combined    with   tartar-emetic   in 

fevers,  or,  better  still,  morphia  may  be  given 
hypodermically.  Laudanum  in  low  muttering 
delirium. 


DELIRIUM  TREMENS. 

Antimony,  214.  Tartar  emetic  with  opium  to 
control  mania  and  sleeplessness. 

Bromide  of  potassium.  316.  Especially  in 
earlier  stages,  and  in  dispelling  delusions  re- 
maining after  partial  subdual  of  attack. 

Capsicum,  316.     To  induce  sleep  in  early  stages. 

Chloral,  283.  Especially  when  administered 
at  the  onset  of  the  symptoms. 

Chloroform,  276.  Inhalation  has  been  ad- 
vised to  procure  sleep. 

Cold  douche,  56.     For  insomnia. 

Digitalis,  355.  Half  an  ounce  of  the  tincture, 
repeated  if  necessary  in  four  hours  and  again  in 
six,  and  afterwards  when  needful  in  two- 
drachm  doses.     (See  ref.) 

Hyoscyamus,  401.  Or  hyoscyamia,  probably 
useful  where  delirium  like  that  of  acute  mter- 
mittent  delirium. 

Ice,  68.     To  head. 

Musk,  261.     With  laudanum. 

Opium,  411.     Given  as  a  rectal  injection. 

,  415.     Hypodermically  or  with  porter  or 

spirits.     Test  urine  first. 

Strychnia,  424.  Hypodermically  to  calm  ex- 
citement and  induce  sleep. 

Wet  pack,  57.  For  insomnia.  May  be  repeated. 
If  patient  strong,  delirium  boisterous  and  pulse 
full,  tartar-emetic  or  aconite  should  be  added. 


DEPRESSION  AND  DESPONDENCY. 

Bromide   of    pot.^ssium,    117.        Especially    in 

towns-people. 
Phosphorus,  235.     In  depression  from  overwork. 


DIABETES. 

Caution. —  The  sugar  reaction  is  given  by  urine 
oj"  patients  taking  salicylic  acid.     See  p.  452. 

AwcAttfis,  140.     Have  been  suggested. 

Ergot,  431.  The  best  remedy  in  diabetes  in- 
sipidus.    Large  doses  required. 

Glycerine,  247.     To  be  used  in  place  of  sugar. 

Lactic  acid,  130. 

Opium,  417.     Very  successful. 

Salicylate  of  soda,  452. 

Tepid  drinks,  72. 

Valerian,  310.  Large  and  increasing  doses  in 
diabetes  insipidus. 


INDEX    TO    DISEASES. 


493 


DIARRHCEA. 

Alkalies,  139.  Bicarbonates  of  potash,  soda  or 
magnesia  when  due  to  excess  of  acid  in  intes- 
tines. 

Alum,  171.  Sometimes  useful  in  acute  and 
chronic  diarrhoea,  and  in  that  of  typhoid  and 
dysentery. 

Ammi)NL\,  148.  In  after  stages  when  mucous 
membrane  continues  to  pour  out  watery  secre- 
tion which  perpetuates  the  diarrhoea. 

Arsenic,  222.  One  drop  of  liq.  arsen.  before 
meals  for  dyspeptics  when  diarrhoea  excited  by 
food. 

Also  useful  in  other  chronic  forms  of  diarrhoea, 
even  when  due  to  organic  disease. 

,  231.  For  copious  discharge  of  mem- 
branous shreds  from  bowels  and  uterus  with 
emaciation,  neuralgia,  dysmenorrhcea,  &c. 

Attention  to  feeding,  202.  Small  quantities 
of  food  frequently. 

Bismuth,  180.  Half  a  drachm  to  a  drachm  of  the 
nitrate  in  chronic  diarrhoea  as  in  that  of  phthisis 
sometimes  valuable  when  all  else  has  failed — 
should  be  given  in  milk. 

A  grain  hourly  with  milk  with  sometimes 
one-si,\th  gr.  gray  powder  in  various  forms  of 
diarrhoea  of  young  children. 

Camphor,  303.  In  summer  diarrhoea,  in  acute  diar- 
rhoea of  infants  (may  be  given  in  milk),  in  diar- 
rhoea caused  by  effluvia  of  drains,  or  exposure 
to  cold. 

Capsicum,  316.  In  summer  diarrhoeas  and  in  those 
persisting  after  expulsion  of  exciting  irritant. 

Castor  oil,  246.  In  early  stages  to  carry  away 
irritant. 

Children's  diarrhoea  sometimes  yields  to  eight 
or  ten  drops  suspended  in  mucilage. 

Chamomile,  456.  An  infusion  useful  in  summer 
diarrhoea  of  adults,  or  of  children  from  teething. 

Chloride  of  ammonium,  159.  In  catarrhal  con- 
ditions of  intestines. 

Chloride  of  c.^lciu.m,  154.  In  chronic  diar- 
rhoea with  weak  digestion. 

Chloroform,  270.  As  sp.  chloroformi  combined 
with  astringents  and  opium  after  removal  of 
excitant. 

Cocaine,  441.  As  anal  injection  or  suppository 
to  check  diarrhoea. 

Cod  li\ek  oil,  243.  In  chronic  diarrhoea  of 
children  with  pale  stinking  motions,  wrinkled 
skin  and  perhaps  vomiting. 

Cold  ok  teitd  packing,  45.  In  summer  diar- 
rhoea of  children. 

Copper  sulphate,  207.  By  mouth  or  as  an  in- 
jection in  severe  chronic  or  acute  diarrhoea  with 
or  without  organic  disease. 

COTO   BARK,  253. 

Flannel  hinder,  202.  Round  the  belly  in  in- 
fantile diarrhoea. 

Injections,  76.  Of  starch  water  at  100  degrees 
F.  with  laudanum  and  acetate  of  lead  or  sul- 
phate of  copper.  Invaluable  in  urgent  cases 
such  as  the  choleraic  diarrhoea  of  children. 

Ipec.'Vcuanha,  320.  Hourly  drop  doses  of  the 
wine,  especially  if  vomiting  be  present,  in  dys- 
enteric diarrhoea  of  children. 

Iron,  174.  Astringent  preparations,  especially  the 
pernitrate. 

Le.\d,  183.  A  fewgrs.  of  the  acetate  with  a  small 
dose  of  morphia,  a  sure  and  speedy  remedy  for 
summer  diarrhoea;  the  acetate  with  opium  in 
purging  due  to  dysentery,  typhoid,  or  tuber- 
cular disease  of  intestines. 

It  increases  the  efficacy  of  a  starch  injection. 
It  may  be  used  as  a  suppository. 

Lime,  carhonate  of,  154.  In  the  later  stages 
when  the  irritant  got  rid  of.  As  chalk  mix- 
ture in  diarrhoea  from  more  serious  causes,  as 
typhoid  or  phthisis. 

Lime-water,  88,  154.  In  chronic  vomiting  with 
diarrhoea  in  young  children. 

"Mercurv.  2.  Generally  best  when  stools  are 
light-colored.  Nitnc  acid  and  nux  vomica 
assist  its  action. 


BlARRUaiA—confiHiiet/. 

For  indications  afforded  by  condition  of 
tongue,  see  p.  i. 

,  200.  A  third  of  a  grain  of  gray  pow- 
der every  hour  or  two  in  diarrhoea  of  children 
with  bad  digestion,  flatulent  distention  and 
clayey  stinking  motions. 

,  200.     Where  children  or  adults  suffer 

from  acute  or  chronic  diarrhoea  with  slimy, 
perhaps  bloody  stools  and  pain  and  straining, 
give  frequent  teaspoonful  doses  of  a  .solu- 
tion of  one  grain  of  bichloride  in  ten  ozs.  of 
water. 

Gray  powder,  a  sixth  of  a  grain  hourly,  then 
every  two  or  three  hours,  m  infantile  diarrhoea 
with  watery  and  offensive,  muddy  or  green 
stools  to  the  number  of  ten  or  twelve  a  day — 
vomiting  is  an  additional  indication  for  this 
treatment. 

In  all  cases  of  infantile  diarrhoea  little  food 
should  be  given,  but  frequently. 

When  children  pass  large,  acid,  offensive 
curdy  stools,  mercury  of  little  use^here  milk 
should  be  entirely  withheld. 

,  202.     The  chronic  diarrhoea  of  adults 

with  watery  pale  stools  often  yields  to  the  hun- 
dredth of  a  grain  of  corrosive  sublimate  every 
two  or  three  hours;  this  may  be  employed  in 
diarrhoea  of  typhoid  or  phthisis. 

Nn  Kic  .^ciD,  2.  With  nux  vomica  to  assist  action 
of  mercury  or  podophyllin. 

,  128.  For  straining  diarrhoea  of  chil- 
dren when  motions  green,  curdled  and  mixed 
with  mucus;  also  in  chronic  diseases  of  children 
with  sour-smelling,  pale  and  pasty  motions,  es- 
pecially if  acid  combined  with  pepsin. 

Opium,  410.  Or  morphia  in  acute  forms  after 
expulsion  of  offending  matter,  also  in  chronic 
diarrhoea  of  tuberculosis,  dysentery,  and  other 
organic  diseases.  In  typhoid  fever,  where  there 
is  wakefulness,  delirium  and  diarrhoea,  it  will 
often  subdue  the  symptoms. 

In  dyspepsia  with  diarrhoea,  common  in 
children  where  there  is  sinking  at  the  stomach, 
relieved  for  a  short  time  by  food,  and  the  occur- 
rence of  an  evacuation  of  partially  digested  food 
immediately  after  the  meal.  I'wo  to  five  drops 
tr.  opii  a  few  minutes  before  each  meal  very 
efficacious,  but  arsenic  even  more  so. 

An  injection  with  starch  in  acute  and  chronic 
diarrhoeas,  including  those  severe  forms  which 
sometimes  carry  off  young  children  in  a  few 
hours.  .Also  in  typhoid  tubercular  ulceration 
of  intestines  and  dysentery  (p.  411). 

Phosphate  of  lime,  i56.  In  chronic  diarrhoea, 
tubercular  01  otherwise. 

,  157.     In  chronic  diarrhoea, 

especially  that  of  young  children,  may  be 
given  with  carbonate  of  lime  and  lactate  of 
iron. 

Podophyllum,  335.  In  chronic  diarrhoea  with 
high-colored  motions  and  cutting  pains  ;  also 
in  morning  diarrhoea  ;  also  in  chronic  diarrhoea 
with  watery,  pale,  frothy  motions,  with  severe 
cutting  pain.    (See  also  p.  2.) 

R.JtW-  MSAT  diet,  469,  470.  For  children  and 
adults. 

Rhubarb,  461.  In  early  stages  to  get  rid  of  irri- 
tant and  afterwards  to  check  the  diarrhoea. 

Salicylic  acid,  452.  As  an  injection  in  dysen- 
teric diarrhoea  of  children. 

SiL\ER,  mtr.ate  of,  190.  In  acute  and  chronic 
diarrhoea. 

Spinal  ice-bag,  69.  For  cramps.  Also  when 
due  to  excessive  action  of  mucous  membrane. 

Sulphuric  acid,  128.  In  summer  and  choleraic 
diarrhoea.  Small  doses  in  chronic  diarrhoea, 
also  in  hectic. 

Tannin,  251.  As  catechu,  kino,  red  gum,  rhatany 
and  hsematoxylum  in  acute  and  chronic  diar- 
rhoea, internallv  or  as  injections. 

Veratrum  album,  328.  Has  been  used  with 
advantage  in  the  vomiting  and  purging  of 
summer  diarrhoea. 


494 


INDEX    TO    DISEASES. 


BlARRHCEA—coiiOutnc/. 

Wet  pack,  45.  Daily  in  chronic  diarrhoea,  due 
to  chronic  catarrh  of  the  intestines. 

Zinc,  oxide  of,  2og.  Two  to  four  gr.  doses  every 
three  hours  in  diarrhcea  of  children. 


(See     Throat,   Diseases 


DIPHTHERIA. 

of.) 

BoRACic  ACID,  133.  In  glycerine  as  local  appli- 
cation. 

Chlorinated  sod.\,  99.  Strona;  solution  to  throat. 

Chlorine  solution,  99.  For  sloughing  of  throat. 

Eucalyptus  oil,  309.  To  the  throat  and  as  in- 
halation. 

Glycerine  of  carbolic  acid,  258.  Twice  a  day 
to  diseased  portions  of  mucous  memb. 

Hydrochloric  acid,  125.     Locally. 

Ice,  68.  To  be  sucked  especially  at  commence- 
ment and  continued  constantly  till  disease 
declines. 

Ice  poultice,  69.  To  throat,  especially  when 
glands  threaten  to  suppurate. 

Iodine,  103.  As  inhalation.  (For  formula  see 
ref.) 

Iron,  177.  Large  doses  of  perchloride — solution 
better  than  tincture — every  hour  or  oftener. 
Solution  also  to  be  gently  painted  on  throat  or 
applied  with  atomizer. 

Lactic  acid,  125.  3  ss  to  3j  in  5J  of  water  as 
spray  or  application  to  membrane  every  hour. 

Lime,  153.  Solution  as  spray.  Recommended 
by  many,  but  of  doubtful  efficacy. 

Per.m.-\nganate,  178.    Has  been  given  internally. 

Pilocarpine,  374. 

Quinia,  442.  As  strong  solution  of  spray  topic- 
ally. 

Silver  nitrate,  189.     Of  doubtful  benefit. 

Strychnia,  420.  Hypodermically  for  paralysis 
after  diphtheria. 

Tannin,  250.     As  spray  (5  per  cent,  solution). 


DIPSOMANIA. 

Arsenic,  222.  For  distressing  vomiting — one 
drop  of  liq.  arsen.  before  breakfast. 

Capsicum,  316.  Large  doses  before  meals,  and 
whenever  depression  and  craving  for  alcohol 
occurs.  With  bromide  or  arsenic  and  bitters  to 
assist  in  overcoming  habit. 


DROPSIES. 

Nature  and  causes  o/,  see  f>.  32. 
Mode  0/  action  0/  remedies,  p.  34. 

Acupuncture,  79.  Or,  better  still,  incisions 
from  three-quarters  to  an  inch  long — one  over 
each  external  malleolus  generally  sufficient. 
Keep  a  hot  moist  sponge  containing  carbolic 
acid  to  incisions,  and  put  feet  and  ankles  into 
hot  bath  for  an  hour  night  and  morning.  More 
useful  in  liright's  disease  and  in  aortic  than  in 
tricuspid  mischief. 

Adonidin,  360. 

Arsenic,  226.     For  swelled  feet  from  debility. 

BiTARTRATE  OF  POTASH,  163.  Especially  in  gen- 
eral dropsies;  useful  in  Bright's  disease  to 
prevent  watery  accumulations  and  to  draw  off 
effete  matters. 

Calomel,  206.  Powerful  diuretic  in  renal  and 
cardiac  dropsy. 

Colocynth,  457.     Has  been  used. 

CoNVALLARiA,  357.     Used  by  Russian  peasants. 

Copaiba,  308.  In  some  cases  of  ascites  and 
Bright's  disease. 

Digitalis.  347.  The  fresh  infusion  is  best  in 
heart  disease. 

Elatekium,  457.  In  kidney  and  heart  disease: 
must  be  employed  cautiously.     (See  ref.) 


DROPSIES— <:^«/?«M^a'. 

Iodide  of  potassium,  in.  In  some  cases  of 
Bright's  disease. 

Jal.\p,  460.  In  combination  with  other  sub- 
stances. 

Juniper,  309.  Esteemed  by  some  in  scarlatinal 
dropsy. 

Squill,  460.     Recommended  in  all  forms. 

Sulphate  of  magnesia,  163.  3ij-lj  in  Jj 
water  before  food. 


DYSENTERY. 

Alum,  171.     For  the  diarrhoea. 

Arsenic,  222.     (See  Diarrhoea.) 

Cocaine,  441.     As  anal  injection  for  straining. 

Ham  amelis,  252.   When  discharges  contain  much 

blood. 
Injections,  77.      A   pint   of  water  with   ten  to 

twenty   grains   of  sulphate   of  copper  in   the 

diarrhcea  of  chronic  dysentery. 

Large    emollient    enemata    useful    in   early 

stages  of  dysentery. 
Ipecacuanha,  320.     Large  doses  required.     The 

dysenteric    diarrhoea    of    children    will    often 

yield  to  hourly  drop  doses  of  ipecacuanha  wine, 

especially  if  vomiting  present. 
Lead,  183.     The  acetate  with  opium  for  purging. 
Mercury,  200.     A  hundredth  of  a  grain   hourly 

or  every  two  hours  of  the  bichloride  in  acute  or 

chronic    dysentery,    if    stools    are    slimy  and 

bloody. 
Opium,  410.     For  the  purging. 


DYSMENORRHCEA. 

ACT.-EA,   337. 

Axtipyrin,  455. 

Arsenic,  231.  When  accompanied  by  copious 
discharge  of  membranous  shreds  from  bowels 
and  uterus. 

Cajeput,  307. 

Cannabis  indica,  292.     Very  useful. 

Croton  chloral,  289.  In  dysmenorrhceal  neu- 
ralgia. 

Gelsemium,  382.     Said  to  be  useful. 

Hamamelis,  252.     Often  relieves  pain. 

Hot  sitz-bath,  52.     Two  or  three  times  a  day. 

Nitrite  of  amyl,  298.     Inhalation. 


DYSPEPSIA. 

AcT.eA,  337.     For  the  dyspepsia  of  drunkards. 

Alcohol,  262.  In  loss  of  appetite  and  digestive 
power  from  fatigue,  a  glass  of  wine  or  a  little 
ijrandy-and-water  before  food  ;  useful  also  in 
indigestion  during  convalescence  from  acute 
diseases  or  in  town-dwellers.  During  acute 
disease  alcohol  should  be  given  with  food,  little 
and  often. 

Alkalies,  125,  126.  Shortly  before  a  meal  in- 
crease gastric  juice,  usually  better  than  acids 
in  atonic  dyspepsia.     (See  also  p.  122.) 

,  138.     Bicarbonate  of  soda  best. 

Aloes,  458.  In  combination,  for  habitual  con- 
stipation with  dyspepsia. 

The  compound  decoction  a  good  after-dinner 
la.xative.  One  grain  of  the  water)'  extract  with 
nux  vomica,  gentian  or  cinchona,  a  good  din- 
ner pill. 

Arsenic.  3.  Indicated  by  a  too  clean,  too  smooth 
red  tongue  with  prominent  papillae. 

,  222.    One  drop  of  liq.  arsen.  before  food 

in'irritative  dyspepsia  and  dyspepsia  in  which 
diarrhoea  is  excited  by  food. 

Belladonna,  388.  One-sixth  to  one-fourth  of 
the  extract  once  a  day  when  there  is  constipa- 
tion. 

Bismuth,  180.  Mixed  with  vegetable  charcoal 
in  flatulent  dyspepsia. 


INDEX    TO    DISEASES. 


495 


Charcoal,  87.  Where  there  is  flatulence.  (See 
ref.) 

Cocaine,  441.  In  nervous  dyspepsia  J^  grain 
three  or  four  times  a  day. 

Cod  liver  oil,  243.  In  the  "craving"  at  the 
epigastrium  of  the  aged  if  intestinal  canal  not 
in  an  irritable  condition. 

CoLCHici'M,  332.     In  gouty  subjects. 

Cold  water,  73.  Half  a  tumbler  half  an  hour 
before  breakfast. 

Creasote,  255.  Often  relieves  stomach  pains 
occurring  after  food. 

Drinking  little  and  only  some  time  after 
MEALS,  72.  In  "indigestion  of  fluids"  (see 
ref.) 

Eucalyptus,  309.     In  atonic  form. 

Hot  water,  73,  74.  A  tumbler  twice  or  thrice 
daily  between  meals  in  flatulent  and  acid  dys- 
pepsia. 

Hydrochloric  acid,  126.  Dilute,  after  a  meal 
increases  gastric  juice. 

Ipecacu.xnha,  317.  In  irritative  dyspepsia,  acute 
and  chronic,  320.  When  associated  with  con- 
stipation, depression,  and  food  lying  on  stomach 
"  like  a  heavy  weight." 

Manganese,  178.  As  permanganate  when  flatu- 
lence. 

Merci  ry,  2.  Asgray  powder  if  constipation  with 
light  colored  stools.  Nitric  acid  and  nu.\ 
vomica  may  be  given  simultaneously. 

For  remarks  on  indication  of  the  tongue  see 
p.  I. 

,  202.    A  grain  of  gray  powder  three  or 

four  times  a  day  in  dyspepsia  occurring  during 
chronic  disease  or  in  convalescence. 

-,  202.     If  constipation,  half  a  grain  of 


calomel  with  three  grains  e.xtract  hyosc.  in  pill 
for  three  nights  is  better. 

Mineral  .\cids,  126.  For  eructations  of  offen- 
sive gas  with  or  without  o.xaluria. 

Morphia,  407.  Hypodermically,  when  dyspepsia 
of  an  irritable  kind  in  an  irritable  subject. 

Nux  vomica,  420.  Where  flatulence,  weight  on 
head  and  heartburn. 

Opium,  410,  411.  When  sinking  at  stomach  re- 
lieved temporarily  only  by  food  which  produces 
an  evacuation  almost  immediately  of  partially 
digested  matters,  common  in  children,  two  to 
five  drops  of  tr.  opii  a  few  minutes  before  meals 
very  useful, — arsenic  even  more  so. 

,  417.     In  nervous  people  with  weight  on 

head,  flushings,  perspirations,  and  depression. 
A  drop  of  laudanum  with  two  of  tr.  nucis  vom. 
three  or  four  times  a  day. 
In  phthisis,  not  febrile. 

Podophyllum,  334.  Useful  when  tongue  furred, 
especially  if  stools  dark.  This  holds  good 
whether  bowels  open  or  constipated,  but  in 
latter  case  i-3oth  to  i-2oth  grain  doses  only.  A 
mi.xture  containing  nu.x  vomica  and  nitric  acid 
should  be  given  at  the  same  time.  If  disagree- 
able taste  persists,  rinse  the  mouth  with  solu- 
tion of  permanganate  of  potash. 

— ,  334.  For  cankery  taste,  espe- 
cially in  the  morning.    If  this  fail,  try  mercury. 

Quinia,  448.  Especially  in  elderly  people  living 
in  towns.  Checks  excessive  fermentation  in 
the  alimentary  canal. 

Senn.^,  462.  Combined  with  gentian  when  there 
is  constipation. 

Sulpho-carbolate  of  soda,  258.  And  carbolic 
acid  both  useful  in  flatulence,  especially  when 
it  occurs  immediately  after  a  meal  or  gives  rise 
to  "spasms."  In  these  cases  phosphorus  is, 
however,  better. 

Tannin,  250.     In  irritative  dyspepsia. 

Turkish  bath,  59.  For  slight  indigestion  and 
malaise  after  dining  out. 


DYSPHAGIA. 

Cocaine,  439.     Painted  over  pharynx. 


DYSPNdA. 

Cocaine,  441.     Internally  when  due  to  weakened 
respiratory  action. 


EAR    DISEASES.       {See   also    Otorrhcca 
and  Deafness.^ 

Aconite,  345.     In  otitis. 

Cocaine,  440.     As  spray  in  otalgia  (see  ref.) 

Counter-irwitation,  84.     By  blistering  fluid  or 

croton-oil  liniment  behind  the  ear  often  relieves 

earache. 
Glycerine,  247.     For  dryness  of  meatus  and  as 

a  film  to  cover  the  tympanum  when  ruptured. 
Strychnia,  420.     Hypodermically. 


ECTHYMA. 

Quinia,  448.     For   mal-nutrition   on   which   the 
ecthyma  depends. 


ECZEMA, 

Alk.vline  lotion,  122.  Weak,  often  useful  in 
weeping  eczema. 

Ah:m,  169.  Applied  to  check  profuse  discharge, 
but  usually  insufficient  to  heal  of  itself. 

Arsenic,  226,  227.  In  chronic  forms,  especially 
of  vulva,  anus  and  scrotum.  Largest  dose  five 
min.  of  liq.  arsenicalis  three  times  a  day,  never 
on  an  empty  stomach.  For  rules  to  be  ob- 
served in  giving  arsenic  (see  ref.) 

Be.nzolx,  307.  I'he  compound  tincture  painted 
on  the  skin  to  allay  itching. 

Bismuth,  180.  Nitrate  or  carbonate,  as  dusting 
powder,  but  generally  greasy  applications  pre- 
ferable. 

Blisters,  84.  Especially  in  eczema  of  hands, 
applied  around  or  near  the  disease. 

Boracic  acid,  133.  As  ointment  or  lotion  in 
ecz.  vulva;,  and  mixed  with  starch  as  a  dusting 
powder  for  infants. 

,  137.     A  teaspoonful  dissolved  in  a 

pint  of  boiling  water  as  a  lotion  in  eczema  of 
the  vulva. 

Bor.\x,  135.  As  glycerine  of  borax  in  eczema  of 
ears  and  scalp. 

Camphor,  301.  As  addition  to  dusting  oowders 
to  allay  heat  and  itching. 

Carbonate  of  pot.^sh  or  soda,  135.  A  weak 
solution  applied  when  raw  surface  weeps  copi- 
ously.    (See  ref.) 

Carbolic  acid,  253.  In  chronic  eczema  or,  bet- 
ter still,  liq.  carbonas  detergens,  oil  of  cade, 
and  oleum  rusci.  In  the  weeping  stage  if  in- 
flammation not  great  ten  min.  carbolic  acid  to 
one  oz.  of  lard,  also  in  eczema  capitis.  Some- 
times tar  better  than  its  ointment ;  on  the  back 
of  hands  undiluted  petroleum,  but  rather  pain- 
ful. 

C.^VRBOLic  .^CID,  253.  Petroleum,  cade  and  car- 
bolic soaps  useful. 

Caustic  potash,  135.  As  liquor  potassse  locally 
in  chronic  eczema. 

Cinchona,  442.  Powdered  bark  locally  to  check 
profuse  secretion,  probably  cheaper  prepara- 
tions of  tannin  as  useful. 

Cocaine,  440.     A  lotion  for  scrotal  eczema. 

CoD-LiVER  OIL,  135.  Or  glycerine  applied  at 
night  to  obviate  brittleness  of  skin  when  caustic 
lotions  used. 

Cyanide  of  potassium,  404.  Or  hydrocyanic 
acid.     (See  Itching.) 

Euc.\lyptol,  309.  With  iodoform  and  vaseline. 
Useful  in  dry  stage. 

Glycerine,  135,  247.  Or,  better  still,  glycerine 
of  starch  for  rough  skin  left  after  eczema. 

Glycerine  of   i'axnin,  249.     In  most  forms. 

Lead,  181.  Soluble  salts  as  lotions  when  much 
inflammation  and  copious  discharge. 


496 


INDEX    TO    DISEASES. 


ECZ  E  M  A — continued. 

If  great  inflammation,  surface  to  be  covered 
constantly  with  rags  soaked  in  the  lotion.  In 
some  cases  a  poulticeat  night  and  lotion  during 
the  day.  A  strong  lotion  best  in  diffused  ecze- 
ma without  weeping,  but  with  much  itching. 
A  we^k  alkaline  or  sulphur  bath  assists  action 
of  lotion.  Equal  parts  of  emp.  plumb,  and 
linseed  oil  applied  on  soft  linen  twice  a  day 
invaluable  in  sub-acute  stage.     (See  ref.) 

Ll.ME,  CARBONATE  OF,  152.     As  dusting  powder. 

LlME-w..\TER,  152.  As  sedative  and  to  check 
discharge.  After  inflammation  subdued  lime- 
water  and  glycerine  a  comforting  application. 

Menthol,  307.     Ointment. 

Mercury,  192.  Citrine  ointment,  especiallj'  when 
skin  healed,  very  useful  when  eczema  attacks 
hairy  parts  of  face,  sometimes  well  to  mix  it 
with  tar  ointment. 

Milk,  135.     With  water  as  local  application. 

Oil  of  cade,  135.  Equal  parts  soft  soap,  recti- 
fied spirit  and  oil  of  cade  night  and  morn. 

Oils  and  f.\ts,  238.  To  prevent  irritation  from 
the  discharge,  generally  mi.\ed  with  oxide  of 
zinc. 

Simple  oils  facilitate  the  removal  of  scabs. 

Paraffin  and  v.aseline,  133.     For  eczema. 

Petroleum  and  vaseline,  253.  For  chronic 
eczema. 

Potato  poultice,  66.  Cold,  sprinkled  with  pow- 
der composed  of  camphor,  talc  and  oxide  of 
zinc,  when  much  inflammation  and  sensation  of 
heat,  or  the  powder  alone  may  be  dusted  over 
the  surface. 

Poultices,  63.     If  skin  is  much  inflamed. 

Salicylic  .\cid,  449.    As  lotion. 

Silver  mtr.\te,  188.  To  be  painted  on  limited 
patches,  most  serviceable  after  weeping  stage. 

Soap,  135.  Moist,  weeping  surface  to  be  washed 
with  soap  and  water  night  and  morn. 

Sulphides,  92,  93.     As  baths,  not  in  acute  stage. 

Sulphur,  92.     Internally. 

Tar,  256.  In  treacle,  pills  or  capsules,  from  three 
to  fifteen  min.  for  a  dose  in  chronic  eczema. 

Turkish  bath,  58. 

Vaseline,  253.  When  skin  dry  and  hard  in 
chronic  eczema. 

War.m  bath,  52.  Especially  in  acute  stages — 
rain-water  best. 

Yolk  of  egg,  :35.  With  water  as  local  applica- 
tion. 

2inc,  208.  The  ointment  of  the  oxide  as  a  mild 
stimulating  application  after  inflammation  sub- 
sided when  raw  surface  indolent. 

Oxide  and  carbonate  used  as  dusting  powders, 
generally  greasy  applications  better.  (See 
P-  152-) 


EMETICS,  DEPRESSION  FROM. 

Ammonia,  148.     Combined  with  other  emetics  to 
obviate  depression. 


EMISSIONS.     {See  Spermatorrhea.) 


EMPHYSEMA.     {See  Bronchitis.) 

Arsenic,  226.  For  emphysematous  persons  who 
on  catching  cold  are  troubled  with  slight 
wheezing  and  some  dyspnoea.  If  bronchitis  or 
dyspnoea  very  severe,  lobelia  or  belladonna 
better.  Arsenic  especially  useful  where  this 
affection  can  be  connected  with  the  recession 
of  a  rash. 

Chloral,  284.  For  the  shortness  of  breath 
brought  on  in  emphysematous  persons  by  catch- 
ing cold.  If  obstructed  circulation,  caution 
required. 

CoD-LivER  oil,  243.     Checks  degeneration. 


EMPHYSEMA.— ^^;;//«M^a'. 

CuBEBS,  308.  3  ss  to  3  j  of  tinct.  thrice  daily  in 
linseed  tea  often  cures  cough  "  like  a  charm." 

Lobelia.  427.  Allays  the  dyspnoja  which  accom- 
panies capillar)'  bronchitis  in  emphysema. 

Purging,  460.     In  obstruction  of  right  heart. 


EMPYEMA. 

Carbolic    acid,  258.      A  weak  solution    to  be 

injected  after  evacuation. 
Chlorine     solution,    99.       For    washing    out 

cavity. 
Iodine,  102.  Solution  to  be  injected  after  tapping. 


ENERGY,   LACK  OF. 

Turkish  b.^ths,  59.      Useful  to  town-dwellers, 
with  soft  flabby  tissues  and  mental  depression. 


ENURESIS.    {See Incontitietice of  Urine.) 

EPIDIDYMITIS. 

Oleate  of  mercury  and  morphia,  194.  Locally. 

EPILEPSY. 

Arsenic,  230.     Sometimes  useful. 

Belladonna,  392.     For  method  (see  ref.). 

Bromides,  115. 

Copper,  207.     The  salts  have  been  given. 

Counter-irritation,  81. 

Musk,  260.     Has  been  given. 

Nitrite  of  amvl,  295,  296.    As  inhalation  or  in 

two  to  five  min.  doses  in  mucilage,  especially 

where  fits  are  \-er>' frequent. 
Nitrite    of   sodiu.m,  300.     In    3j   doses  thrice 

daily. 
Nitro-glycerine,   300.       In   epilepsy    and  the 

status  epilepticus. 
Paraldehyde,  287. 
Silver,  190.     Nitrate  or  o.xide  occasionally  given 

'  with  benefit. 
Spinal  ice-bag,  69. 
Valeri.-vn,  310.     Has  been  used  with  occasional 

advantage. 
Zinc,  iog.      As  oxide  or  sulphate — bromide  of 

potassium  better. 


EPISTAXIS.     {See  Hemorrhage.) 

Aconite,  345.  Small  and  frequent  doses  often 
quickly  check  epistaxis  in  children  and  plethoric 
people. 

Alum,  170.  May  be  injected  or  snuffed  up  in 
powder. 

Cocaine,  439.  Locally  in  hamorrhage  from  nasal 
mucous  membrane. 

Compression  of  facial  artery,  326. 

Digitalis,  355.     The  infusion  best. 

Ergot,  430.  Hypodermically  if  urgent  in  two  to 
five  grain  doses.  May  also  be  given  by  the 
stomach. 

H.\.MAMELls,  252.     (See  Haemorrhage.) 

Hot  foot-b.ath,  52.     With  or  without  mustard. 

Ipecacuanha,  326. 

Spinal  hot-w.\ter  bag,  69.  To  cer\ical  and  up- 
per dorsal  vertebrae. 


ERUCTATIONS,  OFFENSIVE. 

Mineral  acids,   126.      To  correct  the  oxaluria 
on  which  the  eructations  depend. 


INDEX    TO    DISEASES. 


497 


ERYSIPELAS. 

Aconite,  344.  Administered  at  commencement, 
often  at  once  cuts  short  the  attack. 

Very  useful  in  the  erysipelatous  inflammation 
following  vaccination  —  belladonna  ointment 
may  likewise  be  used. 

Ammonium  carbonate,  149.  In  typhoid  condi- 
tion. 

Belladonna,  394.  Internally  and  externally 
may  be  used  with  aconite. 

Carbolic  acid,  258.     Hypodermically  (see  ref.). 

,  257.     A  one  per  cent,  solution  on 

lint  frequently  renewed  relieves  pain. 

Collodion,  236.  Painted  over  superficial  ery- 
sipelas, but  this  often  cracks  and  is  inferior  to  a 
solution  of  nitrate  of  silver  in  water  or  in 
nitrous  ether. 

Digitalis,  355.     Infusion  locally. 

Hot  fomentations,  67.  When  limb  extensively 
aflected. 

Iodine,  100, 102.  Paint  affected  and  circumjacent 
skin  with  solution  to  prevent  spreading. 

Iron,  173.  Tincture  locally,  especially  in  vac- 
cinal form. 

,    177.       Large    doses    of    perchloride    very 

fiequently. 

Permangan.\te,  178.    Has  been  given  internally. 

Salol,  453.     As  dusting  powder  with  talc. 

Silver,  nitrate  of,  188.  The  skin  to  be  well 
washed  with  soap  and  water,  then  with  water, 
and  to  be  wiped  quite  dry — next  a  solution  of 
eighty  grs.  of  the  brittle  stick  to  four  drms.  of 
water,  to  be  applied  two  or  three  times  to 
inflamed  surface,  extending  two  or  three  inches 
beyond  it. 

Sulphurous  acid,  131.  Equal  parts  of  P.B.  acid 
and  glyoerine. 


EXHAUSTION. 

Ammonia,   149.      Internally  its  influence  is  but 

brief. 
Cocaine,  440.    Internally  in  nervous  exhaustion. 
Coffee,  432,  433.     Or  tea,  both  in  hot  and  cold 

climates. 
Phosphorus,   235.      For    physical    and    mental 

exhaustion.     Influence  questionable. 


EXOPHTHALMIC 

Goitre.) 


GOITRE. 


{See 


{See   Conjunc- 


EYE,    DISEASES    OF. 

tivitis.) 

Atropia,  388.  In  iritis  locally.  Hypodermically 
in  glaucoma. 

Belladonna,  388.  Locally  and  internally  in  iritis, 
conjunctivitis,  and  other  inflammations. 

Blisters,  84.  Behind  ear  or  to  temple  in  rheumat- 
ic, gouty  and  simple  inflammation — blistering 
paper  enough.  Obstinate  forms  of  tinea  tarsia 
sometimes  yield  to  flying  blisters  on  the  temple. 

Castor  oil,  246.  Applied  to  allay  pain  from  an 
irritant,  as  sand. 

Chloroform,  269.  Vapor  of,  close  to  a  photo- 
phobic  eye,  relieves. 

Cocaine,  hydrochlorate,  438.  Instillation  of 
a  four  per  cent,  solution  as  local  ansesthetic  in 
various  operations,  sometimes  injection  re- 
quired. Discs  are  a  useful  form.  Ihe  mydri- 
atic effect  may  be  neutralized  by  pilocarpine. 

Mercury,  bichloride  of,  205.  Of  great  service 
in  iritis. 

and  morphia,  oleate  of,  154.  Out- 
side the  eyelids  in  palpebral  conjunctivitis  and 
hordeolum  ;  also  in  syphilitic  iritis. 

Strychnia,  420.  Hypodermically  in  muscular 
asthenopia,  amblyopia,  tobacco  amaurosis,  and 
in  progressive  nerve  atrophy  not  dependent  on 
intra-cranial  disease,  also  in  traumatic  amau- 
rosis. 

32 


F^CES,   HARDENED. 

Enemata,  74.     A   tube  may  be  passed  through 

the  mass  (see  ref.). 
Extraction,  74.     By  finger. 


FAINTINGS. 

Alcohol,  266.     As  brandy  or  wine  when  heart 

suddenly  enfeebled  from  fright,  etc. 
Ammonia,  148.      Breathed  into  the  air-passages. 

,  149.     Internally. 

Chloroform,  270.      Internally,  but  effects  more 

transient  than  those  of  alcohol  ; — often  given  to 

hysterical  people. 
Cold  water    37.     Sprinkled  on  face. 
Position.  266.     Patient  should  lean  forward  with 

the  head  as  low  as  possible  between  the  legs. 


FATIGUE. 

Act.«a,  338.     For  headache  from  over-study  or 

excessive  fatigue. 
Arnica,  45.     A  few  drops  of  tinct.  internally  for 

aching  of  muscles. 
Coffee,   432.      And   tea   both   in   hot  and  cold 

climates. 
Cold  water,  44.     Rubbing  with  wet  towel. 
Dripping  wet  cold  sheet,  45.     As  a  restorative 

and  to  prevent  aching  of  muscles. 
Ether,  278.     For  syncope. 
SiTz  bath,  43.     At  60°  to  80°. 


FAVUS.     {See  Tinea.) 


FEVER,  CHRONIC. 

This  occurs  tn  Abscess^  Ague^  Leucccyihaittia, 
Phthisis,  Kheumatistit,  Syphilis ;  see  under 
each  heading,  also  p.  24. 


FEVERS,  ACUTE. 

Condition  0/ pulse,  see  pp.  4-15. 
Condition  0/  skin,  see  pp.  15,  16. 
Remarks  on    tetnperature,    ivith   hints    as  to 

diagnosis,  see  pp.  17-24. 
Condition  0/  tongue,  see  pp.  1-4. 

Acetate  of  ammonia,  149.  Is  a  good  diapho- 
retic, and  is  especially  useful  in  the  milder 
forms,  as  in  common  catarrh. 

Acid  drinks,  71.  Such  as  raspberry  vinegar, 
citric,  or  tartaric  acid.     (See  also  p.  125.) 

Aconite,  15.  In  small  often-repeated  doses  while 
temperature  high  and  skin  hot  and  dry — most 
successful  when  no  lung  complication.  Where 
there  is,  tartar-emetic  better. 

,  341.  Has  a  marvellous  power  of  con- 
trolling inflammation  and  subduing  fever. 

Alcohol,  2.  When  nervous  depression,  indicated 
by  dry  tongue,  delirium,  and  sleeplessness. 
When  wakefulness  is  the  cause,  it  is  better  to 
try  soporifics  first. 

,  7.  When  pulse  shows  cardiac  weak- 
ness.    Effect  on  pulse  to  be  watched.       , 

,    15.       May   be   indicated    by   profuse 

sweating  at  commencement  (see  ref.). 

266.     When  tongue  and  skin  become 


moist,  the  breathing  more  tranquil,  and  sleep 
gained  under  its  use.     For  rules  see  ref. 

Alkalies,  144.  Citrates  and  acetates  are  consid- 
ered as  febrifuge.  They  possibly  eliminate 
urinary  waters. 

Ammonium  carbonate,  149.  In  typhoid  condi- 
tions of  all  fevers.  Also  given  through  whole 
course  of  scarlatina  and  measles  (see  ref.). 


498 


INDEX    TO    DISEASES. 


FEVERS,  AC\]i:Y.—conli,tued. 

Antimony,  212.  Tartar-emetic  wine  as  a  diapho- 
retic; large  doses  are  given  by  some  to  cut  short 
acute  specific  fevers  and  inflammations.  Ague 
may  sometimes  be  cured  by  antimony,  and  this 
often  assists  quinine  in  curing  it.  Ipecacuanha 
and  other  emetics  should  be  preferred. 

,    214.      When   much   excitement   and 

delirium,  tartar-emetic  in  full,  with  opium  in 
small  doses,  but  if  wakefulness  predominates 
with  not  very  boisterous  delirium,  the  antimony 
to  be  reduced,  and  the  opium  increased. 

Antipyri.ne,  453.      To  reduce  temperature. 

Arsenic,  226.  Sometimes  given  in  prostrating 
acute  fe\-ers  to  strengthen  pulse  and  invigorate 
patient. 

Bell.\donna,  394.     In  delirium. 

BiiTERS,  125.  As  orange-peel  or  cascarilla  mi.\ed 
with  acid  drinks  to  quell  thirst. 

Blisters,  81.  Flying,  or  mustard  poultices  in 
the  semi-comatose  state  sometimes  following 
fevers,  &c. 

Camphor,  302.  In  adynamic  fevers  and  where 
there  is  delirium. 

Carbolic  acid,  259.  Inferior  to  other  antipy- 
retics. 

Castor  oil,  246.     As  purgative. 

Chloral,  283.     In  violent  delirium  of  typhus. 

Cold  afflsion,  47.  At  the  beginning  of  acute 
fevers. 

,  57.  Applied  gently  over  fore- 
head for  headache. 

Cold  b.aths,  46.  47.  Employed  early  diminish 
frequency  of  pulse,  strengthen  heart,  prevent 
delirium,  produce  sleep,  lessen  risk  of  bed-sores 
or  exhausting  suppuration.  The  only  remedy 
in  hyperpyrexia  (see  p.  48). 

Cold  doiche.  57.     In  insomnia. 

Cold  packing,  44.  In  specific  fevers  and  acute 
inflammatory  diseases — especially  useful  on 
retrocession  of  the  rash. 

CoNii'M,  363.  Has  been  recommended  as  it  re- 
duces the  frequency  of  the  pulse. 

Digitalis,  355.  Large  doses  often  required  to 
reduce  temperature,  much  used  in  fevers  on  the 
continent,  especially  recommended  in  typhoid. 

Ether,  278.     F"or  prostration  from  fever. 

EfC.\LYPTUS,  309.  In  intermittent,  but  inferior 
to  quinine. 

Glycerine,  247.  For  keeping  moist  the  lips, 
tongue  and  gums  when  dry,  and  coated  with 
mucus  in  acute  diseases. 

Hot  AFFi'SiON,  57.  Over  forehead  for  headache, 
sometimes  better  than  cold. 

Ice,  71.     To  be  sucked  for  allaying  thirst. 

IcE-B.\G,  57  and  67.  To  forehead  for  head- 
ache. 

MrsK,  261.  And  castoreum  have  been  given  in 
fevers  to  prevent  prostration. 

,   261.       With   laudanum   in   acute   specific 

fevers. 

MisTARD,  314.  As  bath  on  recession  of  the  rash 
of  an  eruptive  fever. 

N.\RCOTics,  2.  Chloral,  bromide  of  potassium  or 
opium  when  ner\-ous  depression,  indicated  by 
dry  tongue  or  delirium  with  sleeplessness. 

Oprm,  414.  For  delirium,  either  noisy  or  mut- 
tering, with  picking  of  bed-clothes.  If  furious, 
tartar-emetic  should  be  combined  with  the 
opium.  Morphia  hypodermically  is  often  the 
best  way  of  administering  an  opiate.  In  ex- 
treme weakness  with  sleeplessness,  and  brown, 
<iry  tongue,  laudanum  helps  a  patient  over  the 
critical  stage  with  less  alcohol  than  would 
otherwise  have  been  required. 

Phenacetin,  455. 

Phosphate  of  lime,  156.     In  hectic. 

QiiNi.\,  446.  Especially  in  typhoid,  but  little  use 
as  anti  pyretic  except  in  rheumatic  fever. 

Salicylic  acid  and  s.\licvlate  of  soda,  450, 
451.  In  large  (one  drachm)  doses  every  night, 
or  in  smaller  and  more  frequent  doses,  reduce 
temperature  in  most  febrile  diseases,  especially 
in  rheumatic  fever. 


FEVERS,  ACVTY.— continued. 

Strychnia,  419.      Hypodermically  for  paralysis 

after  low  fevers. 
Sulphate  of  magnesia,  164.     Or  phosphate  of 

soda  as  purgative  (see  ret.). 
Tart.ar  emetic,   212.      Wine  as  diaphoretic  in 

fevers. 
Veratrum  viride,  328.     Has  been  employed. 
Warm  b.\th  or  warm  sponging,  51.     In  simple 

fe\'er  of  children. 


FISSURE. 

Belladonna,  387.     The  extract  locally. 
Bro.mide  of  potassium,  114.      In  five  parts  of 

glycerine    as   local    application   in   fissures    of 

rectum. 
Castor  oil,  246.     In  fissure  of  anus. 
Ice,  68.     As  a  local  application  to  remove  pain 

after  operation. 
Opium,  411.     With  a  gall  ointment  for  fissures  of 

anus.   Mild  purgatives  should  be  simultaneously 

employed. 
Sulphur,  gi.     As  a  mild   purgative  to  cause  soft 

motions. 


FLATULENCE. 

Abstention  from  sugar  and  starchy  food, 
87,  88.     Also  from  tea. 

A.mmonia,  148.  In  alkaline  preparations  for  flat- 
ulent distension  of  stomach  and  intestines 
(palliative). 

Ass.\FCETiDA,  311.  When  unconnected  with  con- 
stipation or  diarrhoea — useful  for  children, — one 
drachm  of  a  mixture  of  one  drachm  of  the  tinct. 
to  half  a  pint  of  water. 

Bismuth,  88  and  180.  Mixed  with  charcoal  in 
flatulent  dyspepsia. 

C.\LABAR  bean,  367.     At  change  of  life. 

Capsicu.m,  316. 

Carbolic  acid,  258.  Most  successful  when  no 
acidity. 

Carlsbad  water,  162.  Where  acidity,  constipa- 
tion and  pain  at  epigastrium,  over  liver  or 
between  shoulders,  with  sallow  complexion  and 
jaundiced  conjunctivae. 

Charcoal,  86.  Five  or  ten  grs.  soon  after  meal, 
if  wind  half-hour  or  more  after,  but  just  before 
meal  if  wind  formed  during  or  immediately  after 
it.     Obviates  both  wind  and  acidity. 

Chloroform,  270.     Drop  doses,  pure. 

Essenti.'\l  oils,  307.  Especially  of  cajeput  and 
cloves,  or  spirit  of  horse-radish. 

Eucalvptol,  309.     In  change  of  life. 

Glvcerine,  248.     In  tea  or  coffee  with  food. 

Hot-water,  73.     A  tumbler  between  meals. 

Ipecacuanha,  320.  When  constipation,  depres- 
sion and  weight  on  stomach,  especially  in  preg- 
nancy. 

Mercury,  200.  Half  a  grain  three  times  a  day 
when  flatulence  accompanied  by  clayey  stools. 

Nux  vomica,  87  and  424.  When  constipation, 
heartburn  and  weight  on  head. 

SULPHO-CARBOLATES,  258.      MoSt  SUCCeSSful  whcH 

no  acidity. 
SuLPHO-CARBOLATE  OF  SODA,  258.      Or  carbolic 

acid   in  flatulence  occurring  immediately  after 

meals,  also  when  accompanied  by  "  spasms  ;  ' 

here,  however,  phosphorus  better. 
Sulphurous  acid.  132.     In  five  to  ten  min.  doses 

when  produced  by  fermentation. 
Turpentine  or  assafcetida,  76.      One   or  two 

tablespoonfuls   of    turpentine   well    mixed    in 

injection. 


FLUSHING  HEATS. 

Bromide  of  potassium,  118.     Where  mental  de- 
pression at  change  of  life. 
Eucalvptol,  309.     In  change  of  life. 


INDEX    TO    DISEASES. 


499 


FLUSHING  Yl'EA.T?>— continued. 

Nitrite  of  amvl,  298.  A  tenth  to  a  sixth  of  a 
minim  in  thirty  times  its  volume  of  rectified 
spirit. 

Nux  VOMICA,  417.  The  tinct.  combined  with 
small  quantities  of  laudanum  in  so-called  hys- 
teria of  middle-aged  people  with  flatulence, 
weight  on  head  and  perspirations. 

Valerli^nate  of  zinc,  3in.  At  change  of  life. 
Some  prefer  valerian  or  its  tincture. 


GAti-S  TONES. 

Carlsbad   waters,   163.      A   system    required. 

(See  ref.) 
Chloral,  284.     Sometimes  relieves  the  pain. 
Chloroform,  277.     Internally. 
Gelsemium,    382.      Five   drops   of   the   tincture 

every  quarter  of  an  hour.      Relief   quicker  if 

patient  walk  about. 
Phosphate  of  soda,  164.    To  prevent  formation. 
Soda,  carbonate  of,  382.     A  teaspoonful  in  a 

tumbler  or  two  of  hot  water. 


GANGRENE. 

Carbolic  acid,  257.     Locally. 

Charcoal,  86.     Poultices — efficacy  doubtful. 


GASTRALGIA      AND       GASTRITIS. 

{See  Stomachy  diseases  of.) 

GIDDINESS. 

Cod-liver  oil,  243.     In   giddiness  of  the  aged 
when  no  serious  brain  disease. 


GLANDS,  ENLARGED. 

Blisters,  84.     Or  iodine,  loi. 

Creasoie,  257.  Has  been  employed  in  diseases 
of  glands. 

Iodide  of  potassium,  107.     As  ointment. 

,111.  For  mamma  and  tes- 
ticle, but  especially  for  thyroid. 

Iodink,  102.     Tincture  injected  into  gland  itself. 

Mercury  and  morphia,  oleate  of,  194.  In 
obstinate  and  painful  tonsillitis  and  inflamma- 
tion of  lymphatic  glands. 

Soft-soap,  138.  Applications  in  both  scrofulous 
and  non-scrofulous  and  syphilitic  enlargements. 

Sulphide  of  calcium,  95.  For  hard,  swollen 
glands  behind  angle  of  jaw  with  deep-seated 
suppuration. 


GLAUCOMA.     {See  Eye,  diseases  of.) 


GLEET. 

Bismuth,  181.     (See  Gonorrhoea.) 

Blister,  84.     To  perinseum  in  obstinate  gleet. 

Cantharides,  312.     Drop  doses. 

Copaiba,  308. 

Copper,  208.  Solution  of  the  sulphate  as  injec- 
tion. 

Eucalvptol,  309.    In  chronic  catarrh  of  passage. 

Glycerine  of  tannin,  251.  With  an  equal 
quantity  of  olive  oil  or  mucilage  as  injection — 
two  drachms  of  this  mixt.  enough.  Persevere 
eight  or  ten  days  after  discharge  ceased,  and 
do  not  use  at  bedtime. 

Iron,  178.     (See  Gonorrhoea.) 

Lead,  182.     (See  Gonorrhoea.) 

Lime-water,  154.     As  injection. 

Oil  of  sandal  wood,  309.  Fifteen  minims 
three  times  a  day. 


G  LEET — continued. 

Turpentine,  306. 

Zinc,  197.  Half  a  grain  bichloride  of  mercury  in 
water. 

,  208.  The  sulphate  or  chloride  as  injec- 
tion. 


GOITRE. 

Belladonna,  392.  Five  min.  of  the  tinct.  hourly, 
of  great  service  in  exophthalmic  goitre. 

Iodide  of  potassium,  hi.  Internally  and  ex- 
ternally in  hypertrophy  of  thyroid. 

Iodide,  102.  Tinct.  hypodermically  into  the 
gland  Itself. 

,  loi.     Liniment  applied  as  often  as  state 

of  skin  will  permit. 

Mercury,  biniodide  of,  195.  As  ointment  as- 
sisted by  the  sun's  rays,  remarkably  useful  in 
India.     (See  p.  196.) 


GONORRHCEA. 

Aconite,  345.  A  drop  of  the  tincture  each  hour 
in  acute  stage. 

Alkalies,  144.  As  citrates  or  bicarbonates  to 
make  urine  alkaline. 

Avoidance  of  alcohol,  268.     Very  important. 

Bismuth,  181.  Half  an  ounce  with  equal  weight 
of  glycerine  and  three  ounces  water,  useful  as 
injection  in  chronic  stage. 

Blistering,  85.  A  flying  blister  every  night  for 
gonorrhoeal  rheumatism. 

Cannabis  indica,  429.     Occasionally  useful. 

Cantharides,  312.     Drop  doses. 

Cocaine,  440.  Injection  of  a  few  drops  of  two 
per  cent,  solution.     (See  ref.) 

Tampons  soaked  in  cocaine  relieve  pain  of 
blenorrhoea. 

Copaiba,  308.     Best  in  chronic  form. 

Copper,  sulphate  of,  208.  Solutions  are  em- 
ployed as  injections. 

Cup.ebs,  308.     In  large  doses  at  commencement. 

Glycerine  of  tannin,  251.  One  drachm  with 
equal  quantity  of  olive  oil  or  mucilage,  as  in- 
jection in  after  stages.  Persevere  eight  or  ten 
days  after  discharge  ceased.  Do  not  use  any 
urethral  injection  at  bedtime. 

Iron,  178.  I'inct.  perchlor.  half  a  drachm,  tinct. 
opii  one  drachm  to  a  pint  of  water  as  injection, 
or  ferr.  sulph.  gr.  xii.,  tinct.  opii  half  oz.  to 
eight  ozs.  of  water  to  be  used  three  times  a 
day. 

Lead,  182.     As  injection  sometimes  employed. 

Oil  of  sandal  wood,  309.  Fifteen  min.  three 
times  a  day  in  acute  and  chronic  gonorrhoea. 

Silver,  nitrate  of,  191.  An  injection  of  twenty 
grs.  to  the  oz.  said  to  cut  short  the  attack — or 
one  of  one  or  two  grs.  to  the  oz.  may  be  used 
several  times  a  day. 

Probably  tannin  is  better  both  for  gonorrhoea 
and  gleet. 

Sulpho-carbolate  of  zinc,  260.  Twenty  grs. 
to  eight  ozs.  of  water  as  injection  two  or  three 
times  a  day. 

Turpentine,  306. 

Zinc,  208.  A  grain  or  two  of  chloride  in  a  pint 
of  water  injected  hourly,  often  removes  the 
disease  in  twenty-four  to  forty-eight  hours  if 
used  at  the  commencement.  Rest  should  be 
observed  if  possible  If  the  frequent  injection 
causes  pain  in  testicles,  suspend  them  in  hot 
water  and  foment  them  frequently  —if,  notwth- 
standing,  the  pain  and  swelling  increase,  use 
injection  less  often. 


GOUT. 

Aconite,  344.     For  gouty  pains. 
Alkaline    poultice,    67.        Nine   parts  linseed 
meal  to  one  bicarbonate  of  soda. 


500 


INDEX    TO    DISEASES. 


GOUT — continued. 

Antipyrine,  454.    Hypodermically  in  acute  gout. 

Blisters,  85.  A  flying  blister  every  night  in 
chronic  or  subacute  gout. 

Brine  baths,  52.  At  Droitwich  very  useful. 
Also  brine  baths  at  home. 

Carbonate  of  lithia,  137.  Five  grs.  to  the  oz. 
on  lint  applied  round  gouty  enlargements  and 
joints,  especially  if  skin  broken. 

Calsbad  waters,  163.  A  system  required.  (See 
ref.) 

Citrate  of  lithia  or  of  potash,  138.  Used  in 
same  way  as  the  carbonate  of  lithia  when  skin 
broken. 

Cod-liver  oil,  243.     In  chronic  gout. 

Colchicum,  332.  A  drachm  of  the  wine  often 
removes  the  severest  pain  in  an  hour  or  two. 

Useful  in  bronchitis,  asthma,  urticaria,  dys- 
pepsia, &c.,  occurring  in  gouty  persons. 

CoLLODKJN,  236.  The  contractile  variety  with 
or  without  iodine,  painted  over  inflamed  part 
in  acute  gout,  soon  relieves  the  pain.  Too 
many  coats  must  not  be  applied. 

Gu.MACUM,  336.     Has  been  used. 

Iodide  of  potassium,  hi.  Especially  when 
pain  worse  at  night. 

Iodine,  100.  Pamted  round  joints  in  chronic 
gout. 

Iodoform,  279. 

Oil  of  peppermint,  306.  To  be  painted  on 
painful  part. 

Packing,  44. 

Strychnia,  419.  Hypodermically  for  later  stages 
of  gout  paralysis. 

Sulphides,  92.     As  baths  in  chronic  gout. 

Sulphurous  acid,  131.  After  fumigation,  pa- 
tient to  be  covered  with  bed-clothes  which  have 
been  exposed  to  strong  fumes  ;  this  produces 
perspiration,  sleep  and  relief. 

Turkish  baths,  60.  In  subacute  and  chronic 
gout. 

Hot  followed  by  cold  sponging  may  be  use- 
ful as  a  substitute. 

Veratria,  330.  A  strong  ointment  to  painful 
joints  at  onset. 

HAY  FEVER.     {See  Coryza.) 

H/EMATEMESIS.     {See  Hccmorrhage.) 

Alum,  171.     Other  astringents  better. 
Ergot,  430.     (See  Haemorrhage.) 
Hamamelis,  252.     (See  Haemorrhage.) 
Ice,  68.     To  be  sucked. 
Iron,  172.     The  astringent  preparation. 
Lead,  182.     Soluble  compounds  sometimes  used. 
Sulphuric  acid,  127.    Other  astringents  surer. 
Tannin  or  gallic  acid,  250. 
TuRPENTiNK,  304.     In  five  to  ten  drop  doses  very 
frequently. 


HiEMATURIA. 

Camphor,  312.  Two  to  five  grains  when  bloody, 
coagulable  urine  due  to  oil  of  mustard,  turpen- 
tine, copaiba,  or  cantharides. 

Cannabis  indica,  429.  Said  to  relieve  dysuria 
and  strangury.  Bloody  urine  considered  by 
some  to  be  a  special  indication  for  its  use. 

Hamamelis,  252. 

QuiNiA,  448.  Useful  in  some  cases  of  intermit- 
tent haematuria. 

Tannin  or  gallic  acid,  250. 

Turpentine,  304.     In  very  small  doses. 

HEMOPTYSIS.      {See  I/u-tfiorr/ia-r.) 

Common  salt,  159.  Half  a  teaspoonful  taken 
dry  and  repeated  occasionally,  till  nausea  in- 
duced. 

Digitalis,  355.  The  infusion  in  large  doses  very 
useful. 


UMUOVTY'^.l'i— continued. 

Ergot,  430.  Thirty  or  forty  min.  of  the  liquid 
e.xt.  every  three  or  four  hours  or  hourly  in 
severe  cases.  Ergotine  should  be  used  hypo- 
dermically in  very  urgent  haemorrhage,  in  two 
to  five  gr.  doses. 

Hamamelis,  252.     (See  Haemorrhage.) 

Ice,  68.     To  be  sucked. 

Ipecacuanha,  326. 

Iron,  173.     The  acetate.     (See  Haemorrhage.) 

Morphia,  408.  Small  doses  hypodermically  have 
been  employed  successfully. 

Spinal  hot-water  bag,  70.  To  cervical  and 
upper  dorsal  vertebrse. 

Sulphuric  acid,  129.     Supposed  to  be  useful. 

Tannin  or  gallic  acid,  250. 

Turpentine,  305.  In  drachm  doses  every  three 
hours.  This  may,  however,  cause  unpleasant 
symptoms. 


HEMORRHAGE. 

Acids.  124,  e.  g..  Diluted  vinegar  to  leech  bites, 
piles,  cuts,  &c. 

Alcohol,  266.  Brandy  or  wine  when  heart  sud- 
denly enfeebled  by  haemorrhage. 

Alum,  169.  In  slight  haemorrhages,  as  leech 
bites  or  piles,  it  may  be  dusted  on  after  wiping 
dry. 

,    171.      Will   often   check   bleeding   from 

stomach  ;  other  astringents  better. 

Blood,  470.     Fresh  for  prostration. 

Copper,  sulphate  of,  206.  In  stick,  solution, 
or  ointment,  to  arrest  bleeding  from  small 
vessels. 

Creasote,  257.     Or  carbolic  acid. 

Digitalis,  355.  The  infusion  best — large  doses 
may  be  needed. 

Ergot,  430.  Most  valuable  for  haemoptysis, 
epistaxis,  haematemesis  and  intestinal  haemor- 
rhage in  typhoid  fever.  In  urgent  cases  ergo- 
tine should  be  administered  hypodermically  in 
from  two  to  five  gr.  doses.  In  less  urgent 
cases  It  may  be  given  by  the  stomach. 

Ether,  278.  Hypodermically  in  heart  failure 
from  haemorrhage. 

Hamamelis,  252.  In  haemoptysis,  haematemesis, 
htematuria,  epista.xis,  bleeding  piles,  varicocele, 
and  the  oozing  of  blood  persisting  after  a  con- 
finement. Dose,  one  or  two  minims  of  the 
tincture  every  two  or  three  hours. 

Ice,  68.  In  haemorrhage  generally  ;  when  from 
stomach  small  pieces  to  be  swallowed. 

Ipecacuanha,  326.     In  flooding  after  delivery. 

Iron,  172,  173.  The  sulphate  and  ferric  chloride 
solid  or  in  solution.  The  chloride  controls 
bleeding  from  small  vessels,  but  irritates  the 
surface  of  wounds  and  prevents  union  by  first 
intention,  which  carbolic  acid  does  not. 

,  173.     Spray  of  subsulphate  or  insufflation 

of  powdered  sulphate  in  bleeding  from  nose 
or  lungs. 

,  173.  Astringent  preparations  in  haemor- 
rhage of  stomach. 

,  177.  In  haemorrhage  from  lungs  and  kid- 
neys the  acetate  is  best  ;  add  sufficient  water 
to  make  it  taste,  but  not  disagreeably,  and  let 
patient  constantly  sip  this. 

.  177.  Injection  of  perchloride  in  postpar- 
tum haemorrhage. 

Lead,  182.  The  liquor  may  be  used  to  check 
haemorrhage  from  small  vessels ;  other  as- 
tringents better. 

Opiu.m,  418.  Tr.  of  opium  in  a  large  dose  (one 
drachm)  with  brandy  in  profuse  flooding  after 
parturition. 

Quinia,  448.     In  passive  bleeding. 

Saline  transfusion,  154. 

Silver,  nii  rate  of,  187.  Bleeding  leech  bites 
may  be  touched  with  a  stick  of  caustic. 

Spinal  hot-water  bag,  71.  Apply  to  cervical 
and  upper  dorsal  vertebrae  for  epistaxis  or 
haemoptysis. 


INDEX    TO    DISEASES. 


501 


KJEUORRHAGE—cc»itimie</. 

Sulphuric  acid,  127.     In  bleeding  from  stomach. 

,  129.     Supposed  to  check  hoEraor- 

rhage  from  lungs  or  womb. 

Tannin,  250.  In  haemorrhage  from  stomach, 
lungs,  uterus  and  kidneys. 

Transfusion,  154.     Of  saline  fluid. 

— — ,  470.     Of  defibrinated  blood. 

Turpentine,  305.  A  drachm  every  three  hours 
when  from  lungs,  nose,  uterus  or  bladder.  If 
from  kidneys  much  smaller  quantities  must  be 
given. 

Reported  to  be  useful  in  hsemorrhagic  dia- 
thesis. 


HAEMORRHAGE,  POST-PARTUM. 

Compression  of  aorta,  326.  Might  possibly 
be  of  service. 

Ice,  68.     Pushed  into  uterus  or  rectum. 

Ipecacuanha,  326.     Large  doses  recommended. 

Iron,  177.     Perchloride,  diluted,  as  injection. 

Mechanical  ex-citation  of  vomiting,  32  >. 

Opium,  418.  3  j  with  brandy  when  much  ex- 
haustion of  uterus. 


HEMORRHOIDS.     (See  Files.) 


HEADACHE.     (See  Sick  Headache.) 

AcT/EA  racemosa,  337.  In  nervous  or  hysteri- 
cal women,  especially  when  it  occurs  at  the 
menstrual  period  ;  also  when  from  over-study 
or  fatigue. 

Ammonia,  148.     (See  Change  of  Life.) 

Aksenic,  230.     For  throbbing  pain  in  one  brow. 

IjElladonna,  394.  When  pain  over  brows  and 
in  eyeballs — often  due  to  stomach  or  uterine 
derangements — met  with  especially  in  young 
women.  Three  minims  of  the  tincture  every 
three  hours. 

Bit.artrate  of  potash,  163.  Sulphate  of  soda, 
and  tartrate  of  potash  and  soda  control  head- 
ache. 

Bromide  of  potassium,  118.  A  large  dose  in 
nervous  or  sick  headaches. 

Camphor,  301.  A  saturated  solution  in  eau  de 
Cologne  rubbed  on  the  head  in  headache  of 
uterine  origin. 

Chloride  of  .\mmonium,  159.  When  due  to 
menorrhagia  or  amenorrhoea. 

Citrate  of  caffeine,  435.     For  sick  headache. 

Cold  affusion,  57.  Water  poured  gently  over 
forehead,  sometimes  warm  affusion  better. 

Ether  spray,  69.  P"or  frontal  headaches  after 
acute  illness  or  fatigue. 

Friedrichsh.all  w.-\ter,  161.  A  wineglassful  in 
a  breakfast-cupful  of  hot  water  in  bilious  sick 
headache. 

Hot  sponging,  52.  To  face,  temples,  and  neck 
in  influenza,  catarrh,  &c. 

Hot  water,  52.     To  feet  and  legs. 

Ice-bag,  67.      i'o  head. 

Mercury,  205.     As  blue  pill  for  sick  headache. 

,  205.     A  looth  of  a  grain  of  bichloride 

three  times  a  day  when  sick  headache  accom- 
panied by  a  light-colored  diarrhoea.  (See  also 
p.  2.) 

Mustard,  314.  In  a  hot  foot-bath,  or  as  poultice 
or  "mustard  leaf"  to  nape  of  neck  in  various 
forms  of  headache. 

Paraldehide,  287.     In  cerebral  tumors. 

Podophyllum,  335.     In  nervous  headaches  near 

the  menstrual  periods    with   constipation   and 

dark  stools.     Purgative  doses  often  give  relief. 

(See  also  p.  2.) 

Salicyl.\te  of  soda,  451.      Useful  in  15-20  gr. 

doses. 
Sitz-bath,  43.     At  60°  to  80°. 
Tea,  433.     And  coffee  in  headaches   from   ner- 
vousness or  e.xhaustion. 


H  E  AD  AC  H  ¥.— continued. 

Veratrum  viride,  328.  Tincture  in  the  con- 
gestive headache  at  the  menstrual  period. 

Zinc,  oxide  of,  210.  In  two  to  five  grain  doses 
for  nervous  headache.     Bismuth  also  useful. 


HEART,   DISEASES  OF.     (See  Angina 
Pectoris.) 

Aconite,  340.  When  violent  throbbing  and  ex- 
treme pain  in  pericarditis. 

Adonidin,  360.  Similar  to  digitalis — useful  in 
mitral  disease. 

Alcohol,  266.  Brandy  or  wine  when  heart  sud- 
denly enfeebled  by  fright,  loss  of  blood,  acci- 
dent, etc. 

Arsenic,  226.  For  breathlessness  on  exertion 
from  weakly-acting  heart. 

Blisters,  82.  Flying,  over  prsecordial  region  to 
stimulate  the  action  of  the  heart  in  extreme 
weakness. 

Cocaine,  441.  In  palpitation  of  dilated  atonic 
heart. 

Cod-liver  oil,  242.     In  chronic  inflammation. 

,  242.     With  quinine,  for  giddiness 

due  to  weak  heart  in  the  aged. 

Convallaria,  357.  Somewhat  similar  in  action 
to  digitalis. 

DiGiTAiis,  347.  Of  eminent  service  where 
dropsy,  dyspnoea,  livid  face,  frequent  irregular 
pulse  and  dilatation  of  left  ventricle.  The 
freshly-made  infusion  best.  These  cases  re- 
quire alcohol — gin  best. 

,    350.       Where   much   dilatation   and 

hypertrophy  of  left  ventricle  without  valvular 
disease.  It  is  not  contra-indicated  when  aortic 
disease. 

,  350.     Where,   though   the   heart   beats 

tumultuously  and  strongly,  the  pulse  is  weak 
and  dyspnoea  great. 

,  340.  Irregularity  of  pulse  best  indi- 
cation for  digitalis. 

,  351,  352.     A  slight  palpitation  much 

increased  by  catching  cold  often  cured  by  digi- 
talis— sometimes  aconite  better. 

Da  Costa  strongly   recommends 


'■ '    351-    .     .  ,  -  . 

digitalis  for  "irritable  heart."     (See  ref.) 

,  352.  Very  useful  in  pure  hyper- 
trophy due  to  valvular  disease  or  excessive 
muscular  exertion.  Also  in  aortic  regurgitant 
disease  when  compensatory  hypertrophy  ex- 
cessive, 352.  Two  to  five  minims  of  the  tincture 
enough — aconite  often  better. 

Elaterium,  457.     In  dropsy.     Caution  needful. 

Ether,  278.  Hypodermically  in  heart  failure 
(see  ref.). 

Morphia,  407.  Hypodermicilly  for  dyspnoea  of 
disease  of  heart  and  large  vessels  and  of  in- 
trathoracic tumors.  More  useful  in  mitral 
than  in  aortic  disease. 

Nitrite  of  amyi.,  294.  In  cardiac  dyspnoea  due 
to  hypertrophied  and  dilated  heart  ;  also  in 
syncope. 

Poi'LTicES,  63.  Large,  hot,  and  frequently  re- 
newed, in  pericarditis. 

Purging,  460.  With  jalap,  etc.,  in  engorgement 
of  right  side  of  heart  from  emphysema  and 
bronchitis,  mitral  obstructive  or  regurgitant 
disease.  Where  severe  headache  and  pain  at 
epigastrium,  bleeding  gives  instant  ease. 

In  persistent  tricuspid  regurgitation  from 
permanent  distension  of  the  right  heart  ;  pur- 
gatives only  useful  when  an  attack  of  bron- 
chitis causes  an  exacerbation,  461. 

Sparteine,  359. 

Strychni.\,  423.  In  medicinal  doses  it  is  said  to 
strengthen  the  heart  beats. 

Strophanthus,  358. 

Veratria,  330.  As  ointment  to  chest  when  rapid 
irregular  pulse,  hurried  breathing,  much  lividity 
and  dropsy,  palpitation  and  inability  to  lie 
down. 


502 


nSTDEX    TO    DISEASES. 


{Sc'e     Stomach,     Dis- 


HEARTBURN. 

cases  of.) 

HERNIA. 

Chloroform,  276.  Inhalation  to  assist  reduc- 
tion. 

HERPES. 

Acetic  acid,  123.     Applied  to  a  patch  of  herpes 

circinnatus  to  cut  it  short. 
Blisters,  83.     For  obstinate  neuralgia  following 

shingles. 
Collodion,   236.     Painted   over   patches  before 

vesicles  developed,   but  inferior  to  nitrate   of 

silver. 
Hot    fomentations,  67.     Will  often   disperse  or 

restrict  development  of  herpes  labialis. 
Iodine,  102.     Liniment  once  applied  enough  for 

herpes  circinnatus.  # 

Morphia,    oleate    of,    195.       Locally    without 

friction  in  herpes  zoster. 
Silver,  nitrate  of,  188.     To  be  painted  on  the 

warning  patch  of  erythema,  before  or  as  soon 

as  the  vesicles  begin  to  form. 
Veratria,  329.     The   ointment,   one   scruple   to 

two  scruples  to  the  ounce  in  neuralgia  follow- 
ing shingles. 

HICCUP. 

Apomorphia,  327. 

Camphor,  303. 

Chloroform,  270.     Often  combined  with  opium. 

Morphia,    408.     Hypodermically    often    arrests 

persistent  hiccup. 
MiSTARD,  315.     A  drachm  infused  in  four  ounces 

of  boiling  water  has  cured  most  obstinate  cases. 
NiTRO-GLVCERiNE,  300.     Sometimes  cures. 

HOARSENESS. 

Alum,  171.  Ten  grains  to  one  ounce  of  water  in 
chronic  coughs  and  hoarseness  as  spray. 

Borax,  138.  A  piece  the  size  of  a  pea  allowed  to 
dissolve  in  the  mouth. 

Glycerine  of  tannin,  250.  Locally  in  chronic 
inflammation  of  the  throat. 

Ipecaclanha  wine,  325.  As  spray  when  con- 
gestion of  vocal  cords. 

Sllphlrous  ACID,  131.  Inhalation,  spray,  or 
fumigation,  in  clergymen's  hoarseness. 

Tl'Rkish  BATH,  59.  At  commencement  of  a 
feverish  cold  will  often  cut  it  short,  together 
with  the  accompanying  hoarseness. 

HORDEOLUM. 

Mercury'  and  morphia,  oleate  of,  194.  The 
20  per  cent,  ointment  with  lard  outside  the  eye- 
lid. 

HYDROCEPHALUS. 

Croton  oil,  246.  Said  to  remove  fluid  from 
ventricles. 

HYDROCELE. 

Iodine,  102.     Tincture  to  inject  into  cavity  after 

paracentesis. 
Tincture,  102.     To  inject. 

HYDROTHORAX.      {See  Pleurisy.) 

Pilocarpine,  374.     Probably  useful  in  removing 
effusion. 

HYPERESTHESIA. 
Bromide  of  potassium,  118,  120. 


HYPOCHONDRIASIS. 

Bromide  of  potassium,  117.  Where  great  des- 
pondency amongst  males  but  especially  amongst 
female  subjects  who  live  in  towns. 


HYSTERIA. 

Aconite,  345.  For  "  fluttering  of  the  heart  "  in 
nervous  persons. 

AcT.t.'^,  337.     For  headache. 

Alcohol,  265.  With  plenty  of  volatile  ether  ; — 
care  must  be  taken  that  it  does  not  lead  to 
tippling. 

Apomorphia,  327. 

Assafcetida,  311. 

Bro.mide  of  potassium,  120.  Gives  control  and 
prevents  paro.\ysms.  When  verging  on  nym- 
phomania large  doses  required. 

CANNABIS  Indic.\,  429.     In  some  cases. 

Chloroform   270.     Often  combined  with  opium. 

Cod-liver  oil,  243.  In  middle-aged  people  with 
dyspepsia  or  "craving   "  at  epigastrium. 

Iron  177.  A  course  often  useful,  especially 
when  anaemia  or  uterine  obstructions. 

Morphia,  415,  416.  Hypodermically  when  flit- 
ting neuralgia  with  great  depression. 

Musk,  260.     Has  been  given. 

Nux  vo,Mic.\,  424.  The  tincture,  especially  when 
combined  with  small  quantities  of  laudanum, 
of  great  use  in  the  so-called  hysteiia  of  middle- 
aged  people,  with  flatulence,  weight  on  head, 
flushings  and  hot  and  cold  perspirations. 

Opiu.m,  417.  A  drop  of  laudanum  with  two  of 
the  tr.  of  nux  vomica  three  or  four  times  a  day 
for  weight  on  head  with  flushings,  perspira- 
tions, depression,  &c. 

Par.\ldehiue,  287.  As  hypnotic  dose,  30  to  50 
min. 

Phosphorus,  233.     In  hysterical  paralysis. 

Valerianate  of  zinc,  310.  Especially  at  the 
change  of  life, 

Volatile  oils,  307. 

Zinc,  210.  Especially  the  valerianate  in  some 
forms  of  hysteria. 

ICHTHYOSIS. 

War.m  bath,  51. 


IMPETIGO. 

Glycerine  of  tan.nin,  248. 

Oils,  238.     To  facilitate  removal  of  scabs. 

Poultices,  249.     At  night,  to  remove  scabs. 

QUINIA,  448. 

Sulph.xte  of  copper,  206. 

Sulphur,  92.     Internally. 

Zinc,  208.  The  ointment  of  the  oxide  after  in- 
flammation subsided,  when  raw  surface  indo- 
lent ;  oxide  and  carbonate  used  as  dusting  pow- 
ders, but  greasy  applications  generally  better. 

IMPOTENCE. 

C.antharides,  313.  In  large  doses  (twenty  or 
thirty  drops  of  the  tinct.  or  half  a  grain  of  the 
powden  with  iron  and  phosphoric  acid  or  nux 
vomica. 

Strychnia,  424.  Sometimes  useful  in  large  doses 
when  spermatorrhoea. 

INCONTINENCE  OF  URLNE. 

Bell.\donn.\,  394.  The  best  remedy  for  children 
— ten  10  twenty  drops  of  the  tinct.  three  times 
a  day.  If  unsuccessful,  and  no  worms  or  other 
irritation  exist,  try  strychnia,  cantharides,  tur- 
pentine, santonine,  or  galvanism. 

N.  B.  The  child  should  drink  but  little 
some  hours  before  going  to  bed,  and  should  be 
waked  in  the  middle  of  the  night  to  pass  water. 


INDEX    TO    DISEASES. 


503 


INCONTINENCE,  'E.ic.— continued. 

Cantharides,  313.  One  or  two  drops  of  the 
tinct.  three  or  four  times  a  day  in  middle-aged 
women  or  the  aged,  even  when  due  to  paralysis  ; 
sometimes  also  in  children,  but  for  them 
belladonna  is  generally  better. 

Chloral,  284.     In  children. 

Collodion,  237.  Painted  to  forma  cap  over  end 
of  prepuce. 

Ergot,  431.     Said  to  be  useful. 

Iron,  177.  Sometimes  useful  even  when  no 
worms. 

Nitrate  of  potash,  167.  Has  been  recommend- 
ed for  children. 

Strychnia,  424.  Sometimes  useful  for  old 
people  with  paralysis  of  the  bladder ;  also  for 
the  incontinence  of  children. 

INDIGESTION.     {See  Dyspepsia.) 
INFLAMMATION. 

Aconite,  341.  Gives  most  brilliant  results  when 
inflammation  not  very  e.xtensive  or  severe,  as 
in  catarrh  of  children,  tonsillitis  and  acute  sore 
throat.  In  the  graver  inflammations,  as  pneu- 
monia, pleurisy,  &c.,  the  effects  are  equally 
manifest  though  less  rapid,  343.  In  pericarditis, 
with  violent  throbbing  and  extreme  pain, 
aconite  will  quiet  the  undue  action  and  relieve 
the  pain,  344.  It  has  a  beneficial  influence  in 
acute  specific  fevers ;  it  is  of  marked  service  in 
erysipelas  and  the  inflammation  sometimes 
following  vaccination.  It  is  also  of  use  in  acute 
rheumatism,  otitis,  and  gonorrhoea. 

Antimony,  213.  Should  be  given  at  the  begin- 
ning a  quarter  to  half  a  grain  every  two  or 
three  hours,  or  a  lesser  proportionate  dose 
every  hour ;  useful  in  tonsillitis,  pleurisy, 
orchitis,  bronchitis,  puerperal  peritonitis,  in- 
flammation of  breast,  whitlow,  &c. 

Atropia,  400.     In  inflammations  of  eye. 

Belladonna,  388. 

Cod-liver  oil,  242.  In  many  chronic  inflam- 
mations, as  of  the  heart,  lungs  and  kidneys. 

Digitalis,  354.  Large  doses  asserted  to  be 
capable  of  subduing  acute  inflammations,  if 
used  at  the  commencement.  (Aconite  much 
safer  and  better.) 

Fomentations  of  a  small  teaspoonful  of  the 
leaves  in  half  a  pint  of  boiling  water  said  to  be 
valuable  for  acute  inflammation  of  joints  and 
of  the  breast,  and  for  erysipelas.     (P.  355.) 

EucALYPTOL,  309.  In  chronic  inflammation  of 
bladder. 

Fomentations,  66. 

Ice,  67.  In  very  small  pieces  in  a  bladder  ap- 
plied to  inflamed  part. 

Iodine,  102.  The  liniment  in  the  neighbor- 
hood of  local  inflammation  so  as  to  produce 
vesication. 

Menthol,  solution  of,  307.  Painted  several 
times  a  day  over  inflamed  tissue  of  boils  and 
carbuncles. 

Also  for  excessive  inflammation  after  vaccin- 
ation. 

Merciry,  205.  Bichloride  in  iritis,  and  inflam- 
mations of  deep-seated  parts  of  eye  and  in  other 
inflammations,  especially  those  of  serous  mem- 
branes. 

Nitrates,  164.  Opinions  concerning  the  efficacy 
of  these  in  acute  inflammation  discrepant. 

Opium,  405.  Poultices  containing  laudanum  allay 
pain  in  superficial  and  deep-seated  inflamma- 
tion. Mqrphia  injections  sometimes  needed  in 
pleurisy,  pneumonia,  &c.  An  extract  of  opium 
has  been  recommended  as  a  local  application 
for  carbuncles  and  boils  (see  p.  408).  Opium 
wine  of  the  1864  Pharmacopoeia,  which  contains 
no  spices,  is  very  useful  in  the  pain  of  conjunc- 
tivitis dropped  into  the  eye.  Opium  mixed  with 
tannin  or  creasote  may  be  introduced  into  the 
hollow  of  a  painful  tooth  if  the  pain  is  produced 
by  inflammation  of  exposed  pulp. 


INFLAMMATION— fW2//«M^^. 

Packing,  44.     In  acute  inflammatory  diseases. 

Poultices,  62.  I  o  check  formation  of  pus  or 
assist  in  maturation. 

Sulphides,  95.  In  boils  abscesses,  and  deep- 
seated  suppuration. 


INFLUENZA. 

CuBEBs,  308.  3  ss.  to  3  j.  of  tinct.  in  linseed  tea 
for  subsequent  cough. 

Hot  sponging,  52.     For  headache. 

Sulphurous  acid,  131.  Fumigation  or  inhala- 
tion.    (See  ref.) 


INGROWING  TOENAIL. 

Liquor  potass.^:,  136.  Diluted,  constantly  ap- 
plied on  cotton-wool. 

INSOMNIA.      {See  S/eep/essness.) 

Cold  douche,  57.  A  large  sponge,  soaked  with 
cold  water,  iced  if  possible,  is  dashed  against 
the  head,  face,  and  chest  several  times.  The 
skin  is  then  rubbed  dry  with  a  towel. 

Paraldehide,  287.  Dose  30-50  min.  Much  less 
action  on  heart  than  chloral.  Useful  as  hyp- 
notic in  mania  and  hysteria. 

INTERMITTENT  FEVER.  {See  Ague.) 

INTERTRIGO. 

Bismuth,  180.     Nitrate  or  carbonate,  as  dusting 

powder. 
Camphor,  301.     As  addition  to  dusting  powders, 

to  allay  heat  and  itching. 
Carbonate  of  lime,  152.     Or  oxide  of  zinc  or 

bismuth  sometimes  useful  as  dusting  powder. 

More  often  greasy  applications  better. 
Glycerine  of  tannin,  249.     Sometimes  useful. 
Lime-water,  152.     To  prevent  irritating  urine. 
Soap,  136.     Free  ablution  with,  when  caused  by 

acid  secretions,  smear  afterwards  with  greasy 

application. 

lODISM. 

Arsenic,  109.  Combined  with  iodide  mixtures 
will  modify  or  prevent  skin  eruptions. 

IRITIS.     {See  Eye^  diseases  of.) 

IRRITABILITY. 

Chloral,  284.  Five  grains  two  or  three  times  a 
day  in  irritability  with  nervousness  and  rest- 
lessness. 

Sitz-bath,  43.     At  60°  to  80°. 

ITCH. 

Alkalies,  134.     As  soap  or  ointment  to  remove 

cuticle  and  break  up  burrows. 
Baking  of  clothes,  131.  Must  not  be  forgotten. 
Iodide  of  potassium,  107.     As  ointment. 
Storax,  306. 
Sulphur,  88,  90.     Ung.  sulph.  after  bath.     (See 

ref.) 
Sulphur  and  lime,  93. 
Sulphurous  acid,  131.     As  gaseous  bath.     This 

is  the  quickest  method. 

ITCHING.     {See  Pruritus.) 


504 


INDEX    TO    DISEASES. 


JAUNDICE.     ( See  Liver,  diseases  of. ) 

Mercikv,  200.  In  attacks  of  jaundice  lasting 
three  or  four  days  accompanied  by  depression 
and  preceded  by  sickness  and  coated  tongue, 
one-sixth  or  one-third  of  a  grain  of  gray  powder 
taken  at  the  onset  and  repeated  three  or  four 
times  a  day  very  valuable.  If  obstinate  con- 
stipation, a  course  of  Carlsbad  waters  some- 
times more  efficacious. 

Phosphate  of  sou.a,  164.     In  catarrhal  form 


JOINTS,   DISEASES  OF. 

Aconite,  344.     For  pains  in  inflamed  joints. 

Aksenic,  231.  Often  serviceable  in  rheumatoid 
arthritis,  and  nodosity  of  joints.  Large  doses 
long  continued  necessary.  Action  capricious, 
sometimes  useless,  at  others  remarkably  good. 

Cod-liver  oil,  242.     When  strumous. 

Cold  douche,  57.     For  stiffness. 

Digitalis,  355.  As  fomentations.  (See  Inflam- 
mation.) 

Galvanism,  61.     For  stiffness. 

Iodine,  102.  Solution  injected  into  white  swell- 
ings. 

Merci'RV,  193.  Locally  applied,  as  Scott's  oint- 
ment, in  chronic  inflammation  of  knee — better 
still  as  oleate  of  mercury. 

Salicviaie  of  soda,  451.  Locally,  relieves  in- 
flamed joints. 

Turkish  b.\th,  61.     For  stiffness. 


KIDNEYS,  EXCESSIVE  ACTION  OF. 

Spin..\l  ice-bag,  69. 


LAGTATI^N,  EXCESSIVE. 

Alcohol,  268.  As  stout  often  useful — not  always. 
Belladonna,  383.     Internally  or  externally,  or 

both. 
Quinia,  448.     Has  been  recommended. 
Tobacco,  360.   With  lard  extemallv  said  to  arrest 

secretion  of  milk. 


LARYNGISMUS  STRIDULUS. 

Bromide  of  potassium,  114.  When  uncompli- 
cated except  with  convulsions. 

Cod-liver  oil,  243. 

Cold  sponging,  54.  Twice  or  thrice  daily — 
sometimes  immediately  successful — prevents 
convulsions.     Take  care  no  laryngitis. 

Cold  water  dashed  in  face,  54.  Often  arrests 
paroxysm. 

Lancing  gu.ms,  55.  If  swollen,  red  and  hot,  may 
require  repetition. 

Lobelia,  427.     Has  been  employed. 

Spi.nal  ice-bag,  69. 

WoR.vts,  removal  of,  54,  55.  Treat  faulty  state 
of  mucous  membrane. 


LARYNX,  DISEASES  OF. 

Aconite,  341.  In  spasmodic  laryngitis  or  catar- 
rhal croup  very  valuable. 

Caffei.xe,  435.     As  anaesthetic. 

Cocaine,  439.  A  20  per  cent,  solution  locally. 
As  anaesthetic  for  examinations  and  operations. 

Silver,  nitrate  of,  189.  Powdered  or  in  solu- 
tion to  chronically  inflamed  larynx,  as  in 
phthisis. 

Sulphurous  acid,  131.  Inhalation,  spray,  or 
fumigation. 

LEAD  COLIC.     {See  Poisoning  by  Lead.) 

LEAD   POISONING.      {See  Poisoning.) 


LEPRA.     (See  Psoriasis.) 


LEUCORRHCEA. 

Alk.^lies,  122.  A  weak  injection  when  excessive 
secretion  from  glands  of  os. 

Alum,  172.  A  drachm  to  a  pint  of  water  as  injec- 
tion.    (See  p.  136.) 

Bell.adonna,  387.  With  tannin  as  bolus  where 
neuralgia  or  ulceration  of  os. 

When  disease  due  to  over-secretion  of  mucous 
glands  about  the  os,  and  much  pain  present, 
inject  sodse  bicarb,  one  drachm,  tinct.  bellad. 
two  ounces,  aq.  one  pint,     (hee  ref.) 

Bicarbonate  of  potash  or  soda,  136.  One 
drachm  to  a  pint  of  water  as  an  injection,  es- 
pecially when  discharge  alkaline  and  copious. 
(See  ref.) 

BoRACic  .\ciD,  137.     As  lotion. 

Carbolic  acid,  260.  Diluted  as-  injection  for 
vaginal  leucorrhoea. 

Cold  sponging,  56. 

Copper,  207.  Solutions  of  the  sulphate  as  injec- 
tions. 

Ergot,  431.     Said  to  be  useful  in  some  cases. 

Iro.v,  177.     Internally. 

Lead,  182.     As  injection. 

Lime-water,  152.     As  injection. 

Phosphate  of  lime,  156. 

Spin.-\L  ice-bag,  69. 

Tannin,  387.  As  injection.  If  os  ulcerated  a 
suppository  of  tannin  and  cocoa-nut  fat  to 
mouth  of  uterus. 

Zinc,  sulph.^te  of,  208.  Sometimes  added  to 
alum  injections. 


LICE. 

Essential  oils,  306.     (For  formulas,  see  ref.) 
Mercury,  192.     Nitrate  of  mercury  ointment  or 
corrosive  sublimate  wash  for  lice  on  all  parts 
of  the  body. 

The  body  louse  may  be  killed  by  essential  oils, 
as  rosemary,  or  by  powdered  pyrethrum,  or  by 
ointment  of  staphisagna. 

The  under-linen  should  always  be  boiled. 
Mercury,  194.     The  oleate  destroys  lice  immedi- 
ately, and  simultaneously  kills  the  ova. 


LICHEN. 

Alk.^lies,  134.     (See  Pruritus.) 

Arsenic,  227.     Sometimes  useful. 

Cantharides,  312.     Internally. 

Chlorofor.m,  269.     As  ointment  to  allay  itching. 

Cyanide  of  potassium,  404.  Or  hydrocyanic 
acid.     (See  Itching.) 

Mercury,  192.  Calomel  and  nitrate  of  mere. 
oint.  may  be  mixed,  and  tar  oint.  is  sometimes 
added  in  patches  of  obstinate  lichen,  especially 
of  the  hands,  even  when  not  syphilitic. 

Silver,  nitrate  of  iSS.  The  nitrous  ether  so- 
lution to  be  painted  every  day  or  second  day  on 
a  patch  of  lichen  the  size  of  the  palm  with  ex- 
cessive irritation. 

Sulphides,  92.     As  baths. 

War.m  bath,  50. 


LIVER,   DISEASES  OF. 

Euonvmus,  462,463.  As  hepatic  stimulant — prob- 
ably inferior  to  mercury  and  podophyllum. 

Nitric  acid,  127.  In  long-standing  diseases,  as 
congestion  and  cirrhosis,  will  augment  flow  of 
bile  after  liver  has  struck  work  from  excessive 
use  of  mercury. 

Phosphate  of  soda.  164.  10  gr.  doses  in  milk  for 
children  passing  pasty  white  stools. 

Sulphates,  164.  In  purgative  natural  waters — 
small  doses  oft  repeated — sulphate  of  potash 
occasionally  poisonous. 


INDEX    TO    DISEASES. 


505 


LOCOMOTOR  ATAXY. 

Antipyrine,  454.     For  pains. 

Calabar  bean,  367.    Has  proved  very  beneficial. 


LOINS,  PAINS  IN. 

Lead,  182.  As  plaster,  when  pain  due  to  weak- 
ness, better  than  a  pitch  plaster. 

Also  useful  when  pain  due  to  uterine  disease 
or  piles. 

LUMBAGO. 

AcT.iiA  RACEMOSA,  337.  Said  to  subdue  lumbago 
more  effectually  than  pry  other  remedy. 

Acupuncture,  77,  78.  Succeed?  best  when  loin 
muscles  of  both  sides  afiected,  pain  being  most 
severe  on  to-and-fro  movement.  Needle  to  be 
run  an  inch  or  more  over  seat  of  greatest  pain 
on  each  side.  Sometimes  on  withdrawal  cure 
is  complete.  When  sciatica  associated  with  it, 
lumbago  hard  to  cure.  Acupuncture  useless 
when  high  fever,  or  when  acute  rheumatism  is 
commencing. 

Belladonna,  383.  As  plaster  very  valuable  for 
persistent  remains  affecting  a  small  spot. 

Capsicum,  316.  A  strong  infusion  applied  on 
lint. 

Ether  spray,  ' 
mixture. 

Faradization, 
acupuncture. 

Galvanism,  64,  69.     Highly  useful. 

GUAIACUM,  336. 

Hot  flat  iron,  78.  The  back  to  be  ironed,  a 
piece  of  brown  paper  intervening. 

Ice  and  salt,  68.  Locally  applied  as  freezing 
mixture. 

Iodide  of  potassium,  hi. 

Morphia,  407.  Hypoderraically  injected,  often 
successful  at  once. 

Nitrate  of  potash,  167.  Ten  grains  hourly  or 
every  two  hours  when  urine  scanty  and  high- 
colored,  becoming  turbid  on  cooling. 

Plaster  of  lead  or  pitch,  78.  Applied  after 
cure  effected. 

Poultices,  64.  Very  hot.  Should  be  continued 
for  three  hours,  then  the  skin  covered  with 
flannel  and  oiled  silk. 

Salol,  453.     10  to  15  grs.  hourly. 

Thermic  hammer,  77. 

Turkish  bath,  61. 

Turpentine,  304.     In  twenty-drop  doses. 

Veratri'M  vikide,  32S.  As  tincture,  said  to  be 
useful. 


Locally  applied   as   freezing 
Almost    as    successful    as 


LUNGS,      HYPOSTATIC     CONGES- 
TION OF. 

Blisters,  82.  Flying  blisters  to  chest  and  per- 
haps along  pneumogastric  nerves. 

LUPUS. 

Arsenic,  216.    Arsenious  acid  as  a  caustic. 

Blisters,  82.     In  erythematous  lupus. 

Cfeasote,  257 

Iodine,  101.  As  tincture  or  liniment  to  edges 
and  around. 

Lead,  182.  Liq.  plumbi  with  one  or  two  parts 
glycerine,  applied  warm  after  crusts  removed 
in  milder  forms. 

Mercury,  195,  iq6.  Ointments  in  erythematous 
lupus — calomel  oint.  in  scrofulous  and  tuber- 
cular lupus  of  children. 

Acid  nitrate  for  touching  summit  of  tubercle  ; 
if  application  painful,  cover  spots  with  collo- 
dion. 

Silver,  nitrate  of,  188.  A  weak  solution  grad- 
ually strengthened  in  superficial  kinds  of  lupus. 

Zinc,  208.     Chloride,  iodide   and  nitrate   locally. 


MALARIA.      {See  Ague.) 

Iodine,  104. 

Quinia,    445,    446.     And    allied    alkaloids     (see 

Ague),  also  for  neuralgia  dependent  on  malarial 

poison. 
Turkish  bath,  60.     The  cautious  use  of  for  those 

suffering  from  various  diseases  caused  by  long 

residence  in  a  tropical  climate. 


MAMMARY  ABSCESS. 

Belladonna,  383.  (See  Breasts,  inflammation 
of.) 

Mercury  and  morphia,  oleate  of,  194.  Local- 
ly- 

Sulphide  of  calcium,  95.  Internally — occasion- 
ally the  pain  is  temporarily  increased. 

Tobacco,  360.     The  leaves  as  a  poultice. 


MANIA,  ACUTE, 

Act.ba,  337.  After  confinement  or  during  preg- 
nancy. 

Bromide  of  potassium,  119. 

Cannabis  indic.a,  429.  A  drachm  of  the  tinct. 
with  a  drachm  of  bromide  of  potassium. 

Chloral,  283.    In  acute  and  puerperal  mania. 

Cold  douche,  57.  In  maniacal  delirium — place 
patient  in  a  warm  bath  during  the  application. 

Croton  oil,  246.  As  a  purgative — a  quarter  or 
third  of  a  minim  every  hour. 

Gelsemium,  382.     When  sleeplessness. 

Hvoscyamia,  401.  In  violent  intermittent 
forms. 

Hyoscyamus,  401.  To  produce  sleep  and  calm 
violent  delirium. 

Morphia,  407.     Hypodermically  to  induce  sleep. 

Opium,  415.  Many  cases  may  be  satisfactorily 
treated  with  opium  and  tartar-emetic. 

Paraldehide,  287.  Dose  30-50  rain,  as  hyp- 
notic. 


MEASLES. 

Aconite,    343.     To   moderate    the   catarrh  and 

bronchitis. 
Carbonate  of  ammonium,  149.     In  three  or  five 

grain  doses,  every  two  or  three  hours. 
Cold  affusion,  56.     At  commencement.         ^ 
Fat,  238.     Hands  and  feet  to  be  rubbed  with  a 

firm  fat  to  remove  heat  and  tightness  produced 

by  rash. 
Iodine,    102.     Tinct.  inhal.  for   hoarseness   and 

wheezing. 
Mustard,  314.     As  bath  on  sudden  retrocession 

of  rash. 
Packing,  44.     Especially  on  retrocession  of  rash. 
Purgatives,  165.     Must  be  given  with  caution. 
Veratrum  viride,  328.     Has  been  employed. 


MEGRIM     AND      MIGRAINE.      {See 
Sick  Headache.) 

MELANCHOLIA. 

Bromide  of  potassiu.m,  117.  For  townspeople, 
especially  women,  with  unendurable  despon- 
dency. 

Camphor,  303. 

Morphia,  408.  Hypodermically  useful  in 
patients  with  a  peculiar  idiosyncrasy. 

MisK,  260.     Also  castoreum. 

Phosphorus,  235. 


MENIERE'S  DISEASE. 
A  ural. ) 


( See    Vertigo, 


506 


INDEX    TO    DISEASES. 


MENINGITIS. 

Antimony,  210.  Tartar-emetic  ointment  as 
counter-irritant  to  scalp  in  tubercular  men- 
ingitis. 

Bromide  of  potassium,  117.  In  the  convulsions 
after  simple  meningitis. 

Croton  oil,  246.  Internally  in  hydrocephalus 
supposed  to  remove  excess  of  fluid. 

Ice,  67.     In  a  bag  as  a  cap. 


MENORRHAGIA. 

Act^ea,  337.  For  headache  accompanying  pro- 
fuse menstruation. 

Bromide  of  potassium,  120.  Most  useful  in 
young  women  ;  if  loss  only  at  natural  period 
commence  bromide  a  week  before,  and  dis- 
continue when  it  has  ceased  till  a  week  before, 
next  time. 

If  loss  occur  every  two  or  three  weeks,  give 
bromide  continuously — ten  gr.  dose,  but  more 
when  organic  changes  in  womb. 

Cannabis  indica,  429.     Very  useful. 

Chloride  of  ammonium,  15Q.     For  headaches. 

Digitalis,  355.  Permanently  efficacious  when  no 
organic  disease,  often  temporarily  so  when 
there  is. 

Ergot,  431.  Of  great  use  in  all  forms,  even  when 
the  haemorrhage  proceeds  from  tumors. 

Hamamelis,  252.     Or  hazeline. 

Lemons,  130.     Sucking — a  domestic  remedy. 

Oil  of  cinnamon,  308.     Drachm  doses, 

Phosphate  of  lime,  156.  In  anaemia  from  ex- 
cessive menstruation. 

Quinia,  448.     Has  been  recommended. 

Spinal  hot- water  bag,  71.  To  lower  dorsal  and 
lumbar  vertebrae. 

Tannin  and  gallic  acid,  251. 


MENSTRUATION,  DISORDERS  OF. 

(See  Amenorrhcea  and  jMenorrhagia.) 

MICTURITION,     FREQUENT.      {See 
Incontinence  of  Urine.) 

Cantharides,  313.  In  women  who  micturate  too 
frequently  or  involuntarily  on  coughing  from 
weakness  of  sphincter.     t)neor  two  drop  doses. 

MICTURITION,    PAINFUL. 

Alkalies,   140.      When  caused  by  uric  acid  in 
spicular  crystals  in  young  male  children. 
The  citrates  are  best  suited  for  this. 

Camphor,  304. 

Cannabis  indica,  429.  Said  to  relieve  dysuria 
and  strangury  ;  bloody  urine  said  to  be  a  special 
indication  for  this. 

Cantharides,  313.  A  drop  of  the  tincture  (some- 
times five  required)  three  times  a  day  for  fre- 
quent desire  to  micturate  with  pain. 

MIGRAINE.     ( .S-^^  Sick  Headache. ) 

MOSQUITOES. 

Carbolic  acid,  260.  A  weak  solution  sponged 
over  the  body  to  keep  off  mosquitoes. 


MOUTH,   DISEASES  OF. 
titis.) 


{See  Sloma- 


Arsenic,  216.  In  a  peculiar  circular  rash  on  the 
tongue,  usually  in  children  associated  with 
stomach  or  intestinal  disturbance,  or  a  body 
rash  ;  also  in  sloughing  of  the  mouth  or  throat, 
cancrum  oris,  &c. 


MOUTH  DISEASES— r^«/?««^^. 

Chlorate  of  potash,  168.  In  ulceration  of  gums 
and  the  parts  of  the  tongue  and  cheek  in  con- 
tact with  this. 

In  follicular  and  phagedenic  ulceration. 

Chlorine  solution,  168.     In  ulceration. 

Cocaine,  439.  A  solution  painted  over  fissures, 
ulcers,  and  painful  swellings  on  tongue,  lips,  or 
mucous  membrane  of  cheeks.  Must  be  repeated. 

Creasote,  254.  Or  carbolic-acid  gargle  or  wash 
in  sloughing. 

Lime-water,  153.  In  inflammatory  and  ulcera- 
tive diseases. 

Salicylic  acid,  452.  One  part  (dissolved  in  al- 
cohol) to  250  of  water  in  catarrhal  stomatitis 
and  thrush. 

Silver,  nitr.\te  of,  189.  Applied  to  ulcers  of 
mouth. 

Sulphate  of  copper,  206.  Applied  solid  to  in- 
dolent sores  of  tongue. 

Solution  painted  over  edges  of  gums  in  ulcer- 
ative stomatitis,  but  generally  dried  alum  is 
better. 


MUCOUS    MEMBRANE,    DISEASES 
OF. 

Nitric  acid,  124.  When  reddened,  inflamed  and 
glazed. 

MUCOUS        TUBERCULES.  {See 

Syphilis.) 

MUMPS. 

Mercury,  198.  The  third  of  a  grain  of  gray 
powder  three  or  four  times  a  day  very  useful 
relieving  pain  and  swelling. 

Pilocarpine,  374. 

MUSCLES,  ACHING  OF,  FROM  EX- 
ERTION. 

Arnica,  45. 

Dripping  wet  sheet,  45.     Well  rub  afterwards. 

Turkish  bath,  60. 

MUSCULAR  RIGIDITY. 

Spinal  ice-bag,  70.  If  due  to  disorder  of  ner- 
vous centres. 


MYALGIA. 

Belladonna,  383.  Often  successful  as  liniment, 
though  sometimes  an  opium  liniment  better. 

Chloride  of  ammonium,  159. 

Ether,  64.     As  spray. 

Iodine,  ioi.  The  ointment  for  pain  in  the  mus- 
cles of  the  chest,  these  being  tender  on  pressure, 
but  the  skin  may  be  pinched  without  pain. 

Opium,  405.  Poultices  or  frictions  with  laudanum. 

Poultices,  64.  Very  hot,  followed  by  applica- 
tion of  lint  and  oilskin. 


N^.VUS. 

Zinc,  208.     Chloride,  iodide,  and  nitrate  locally. 

NEPHRITIS.      {See  Brishi' s  Disease.) 

NERVOUS     HEADACHE.       {See    Sick 
Headache.) 


INDEX    TO    DISEASES. 


507 


NERVOUSNESS. 

Bromide  of  potassium,  117.  Especially  for 
women  who  are  despondent,  irritable  and  sleep- 
less, from  overwork,  grief,  worry,  &c.,  often 
connected  with  migraine. 

Chloral,  284.     When  restlessness  and  debility. 

Chloroform,  270.  As  spirits  of  chloroform  in- 
ternally. 

Cold  sponging,  56.    When  from  close  rooms,  &c. 

MoRBHiA,  415.    (See  ref.) 

NETTLE  RASH.     {See  Urticaria.) 


NEURALGIA. 

Aconite,  338  As  ointment  or  liniment,  espe- 
cially when  fifth  nerve  affected,  also  in  neural- 
gic sick  headache — sometimes  veratria  better, 
339.  Spinal  irritation  and  intercostal  neuralgia 
generally  yield  better  to  belladonna  prepara- 
tions. 
Acupuncture,  79.      At   "corresponding  spot" 

on  the  opposite  side. 
Alcohol,  265.     With  much  volatile  ether — care 

must  be  taken  in  prescribing  it. 
Arsenic,  230.     In  various  neuralgias,  also  in  an- 
gina pectoris. 
Atropi.a,  392.      Trousseau's   method — give   one 
fifth  gr.  extr.  bell,  every  hour  till  giddiness  in- 
duced, then  lessen  dose,  but  continue  the  medi- 
cine for  several  days. 
Belladonna,  383  and  388.     The  liniment,  or  the 

ointment  of  atropia  sometimes  useful. 
Cannabis  indica,  429.     Has  been  found  useful. 
Capsicum,  316.    A  strong  infusion  on  lint  covered 

with  gutta  percha. 
Carbonic  acid    gas,  88.      Injected  into  vagina 

for  neuralgia  of  uterus. 
Chamomile,  456.     In  neuralgia  of  the  fifth  nerve. 
Chlor.\l,  285.     Sometimes  relieves. 

Rubbed  with  an  equal   weight   of   camphor 
and  painted  on  painful  part  or  gently  rubbed 
in,  often  useful  in  neuralgia,  pleurodynia,  and 
toothache. 
Chlorate  of  potash,  169.      Has   been   recom- 
mended in  facial  neuralgia. 
Chloride  of  ammonium,  159.     In  half-drachm 
doses  in  facial  neuralgia,  much  used   also   for 
all  neuralgias. 
Chloroform,  269.     Occasionally  useful  locally. 
As  spray    for   neuralgia   of   uterus.      'i'wo   or 
three  drops  on  cotton-wool  in  ear  for  faceache 
and  toothache. 

,  276.     Inhalation. 

■ ,  277.     Subcutaneously.     (See  ref.) 

Cocaine,  440.     ^  to  1,4  gr.  in  solution  hypoder- 

mically  in  course  of  nerve. 
CoNiUM,  364.     Internally. 

Counter-irrit.\tion,  83.  A  blister  to  temple  or 
behind  the  ear  of  the  greatest  service  in  frontal 
and  facial  neuralgia — that  depending  on  a  dis- 
eased tooth  often  yields  to  a  blister,  also  the 
migratory  neuralgic  pains  in  nervous  women 
and  intercostal  neuralgia  left  by  shingles. 
Blisters  should  be  applied,  according  to  Anstie, 
to  a  posterior  branch  of  the  spinal  nerve-trunk 
from  which  the  painful  nerve  issues. 

If  blistering  paper  does  not  succeed  in  neu- 
ralgia a  stronger  preparation  to  be  tried. 
Croton-chlokal,  291.     Five-gr.  doses,  especially 
in  facial  neuralgia,  in  that  due  to  carious  teeth, 
in  that  of  the  neck  and  back  of  head,  in  dys- 
menorrhoeal  neuralgia,  and  in  epileptiform  tic. 
Ergot,  431.     Said  to  be  useful. 
Ether,  278.     As  spray  sometimes  relieves  per- 
manently, often  only  temporarily. 
Gelsemium,  375.      In   non-inflammatory  tooth- 
ache and  neuralgia  of  nerves  supplying  teeth 
and  alveolar  processes. 

,  382.     When  dental  nerves  affected 

even  where  carious  teeth.  Sometimes  to.xic 
doses  required.  Said  to  be  useful  in  ovarian 
neuralgia. 


'^'E\5KKLGIA— continued. 

Hydrocyanic  acid,  404.     And  cyanide  of  potas- 
sium formerly  employed  locally. 
Hvoscyamus,  401. 

Ice,  68.     Locally  in  neuralgia  of  testes. 
Iodoform,  279.     As  saturated  solution  in  chloro- 
form locally. 
Iron,  176,  177.     When  associated  with  ansmia, 
but  no   organic  cause.      Moderate   doses  only 
required. 

Methyl  chloride,  278.  As  spray  especially  in 
sciatica  (see  ref.) 

Morphia,  oleate  of,  194.  One  or  two  grains  to 
a  drachm,  locally. 

Nitrite  of  amvl,  295.  Inhalation  when  fifth 
nerve  affected. 

Oil  of  peppermint,  306.  To  be  painted  over 
the  part  in  facial  neuralgia. 

Opium,  407.  Or  a  hypodermic  injection  of  mor- 
phia— sometimes  a  single  injection  will  cure 
old-standing  cases,  if  not  it  may  be  repeated 
every  second  day  or  so  for  some  time. 

Phosphorus,  234.  From  i-iooth  to  i-i2th  gr. 
every  three  hours.  Very  useful  in  all  forms  of 
neuralgia,  especially  when  uncomplicated. 

QuiNiA,  446.  In  periodical  neuralgia,  whether 
malarial  or  not,  large  doses  should  be  given 
just  before  the  expected  attack. 

Useful  also  in  small  frequently  repeated 
doses  in  other  neuralgias,  especially  of  the 
supra-orbital  nerve. 

Salicylate  of  sod.a,  451.  Inferior  to  other 
remedies. 

Spinal  ice-bag,  70. 

Stramonium,  403.     Has  been  used. 

Valerianate  of  zinc,  310.  Or  of  ammonia  in 
neuralgia  of  face  or  head. 

Veratria,  329.  An  ointment  of  the  pharmaco- 
pceial  strength  enough  for  the  face,  but  stronger 
ones  necessary  for  sciatica  and  other  neural- 
gias, also  for  the  pain  consequent  on  shingles. 

,  328.     Tinct.  of  veratrum  viride  said 

to  be  useful. 


NIGHTMARE. 


Bromide  of  potassium,  119. 


NIGHT  SCREAMING. 

Bromide  of  potassium,  119.  In  children's  at- 
tacks of  night  screaming  often  associated  with 
squinting.  Digestive  organs  to  be  attended  to 
also. 


NIPPLES,  SORE. 

Arnica,  236.     The  cerate. 

Brandv-and-water,  152.  To  be  used  as  lotion 
before  delivery  and  after  each  sucking  to  pre- 
vent cracking.  Nipples  should  be  washed  and 
dried  immediately  after  child  is  removed.  (See 
p.  261.) 

Collodion,  236.  Sometimes  applied  to  chapped 
nipples. 

Glycerine,  247.  Of  starch  or  with  eau  de  Co- 
logne. 

Lime-water,  152.     As  lotion. 

Sulphurous  acid,  131.  Solution  neat  or  dilu- 
ted, constantly  applied. 

,  236.     With  equal  quantity  of 

glycerine  as  lotion. 

Zinc  shield,  152,     Constantly  worn. 


NODES. 

Iodide  of  potassium,  107.  As  ointment  in  con- 
junction with  internal  use. 

Mercury,  oleate  of,  195.  Externally  very 
valuable. 


508 


INDEX  TO  DISEASES. 


NOSE,  DISEASES  OF. 

Ammonia,  148.  Inhalations,  in  pain  and  inflam- 
mations of  nose  and  frontal  bones. 

COD-LIVEK  OIL,  242.     For  chronic  discharge. 

Glycerine  of  t.anmn,  248.  For  brushing  out 
inside  of  nose  when  excoriated  after  measles, 
scarlatina,  <S:c.  Also  for  impetiginous  erup- 
tions of  inside  of  nose,  most  severe  where  hair 
grows— epilation  sometimes  needful.  Glycerine 
of  starch  or  zinc  ointment  applied  often  is  a 
good  supplementary  application. 

,  249.      In   the   discharge 

of  greenish-black  stinking  mucus. 


NUTRITION,  IMPAIRED. 

CoD-LivEK  OIL,  243.     Especially  in  children. 
Lime,  154.     As  lime  water  or  carbonate  of  lim 
Small  doses  as  good  as  large. 


NYMPHOMANIA. 

Bromide  of  potassium,  120.      Large   doses   re- 
quired, at  least  twenty  grs.  three  times  a  day. 
Ca.mphor,  303. 


OBESITY. 

Alkalies,  140.  Solutions  of  oxides  or  bicarbon- 
ates.     Use  very  questionable. 

,  140.     Liquor  potassse.     This  usually, 

however,  fails. 

Vinegar,  127.  A  remedy  to  be  strongly  con- 
demned, as  it  only  reduces  obesity  at  the  ex- 
pense of  serious  injury  to  the  body. 


OESOPHAGUS,  STRICTURE  OF. 

Nutritive  enemat.a,  77.     When  swallowing  im- 
possible.    For  directions  (see  ref .) 


ONYCHIA.      {St-e  Paronychia.) 


OPHTHALMIA. 

Alum,  170.  Eight  grains  to  one  ounce  applied 
every  quarter  or  half  hour  in  simple  and  es- 
pecially in  purulent  ophthalmia  of  children. 

Antimony,  214.  As  tartar-emetic  1-36  to  i-48th 
grain  three  or  four  times  a  day  in  strumous 
ophthalmia.  Sharp  purgation  at  commence- 
ment useful. 

Cakbonic  acid  gas,  88.  Said  to  relieve  pain 
and  photophobia  of  scrofulous  ophthalmia  when 
applied  to  the  eye. 

Cod-liver  oil,  242.    When  strumous. 


OPIUM,  DISAGREEABLE  SYMP- 
TOMS OF,  {See  Poisoning  by 
Opitim.) 


ORCHITIS. 

Antimony,  213.  As  tartai'-emetic  in  acute  orchi- 
tis.    (See  Inflammation.) 

Ice  locally  applied,  68.  Also  in  neuralgia  of 
the  testis. 


OTITIS.     {See  Ear,  diseases  of,  and  Otor- 
rhea.) 


OTORRHCEA.      (.S'^-.f  Ear,  diseases  of.) 

Aconite,  345.     In  otitis. 

All'.m,  170.  Strong  solution  (sixty  grains  to  one 
ounce)  but  inferior  to  glycerine  of  tannic  acid. 

Cod-liver  oil,  242.     When  chronic. 

Glycerine  of  tannin,  249.  Meatus  to  be  filled 
and  plugged  with  cotton-wool — not  in  acute 
inflammation  of  meatus. 

Lead,  182.  Solutions  of  acetate  or  dlacetate  as 
injection,  especially  when  acute  stage  just  sub- 
sided—in later  stages  stronger  astringents 
needed. 

Lime-water,  152.  As  a  wash  when  active  in- 
flammation present.  In  chronic  cases  far  in- 
ferior to  astringents  such  as  glycerine  of  tannin. 


OVARIAN  NEURALGIA. 

Gelsemium,  382.     Said  to  be  useful. 

OVARIAN  TUMORS. 

Iodine,  102.     Ten  oz.  of  tincture  injected  after 
tapping. 

OVERWORK. 

Bromide   of   potassium,  117.     When  insomnia, 

bad  dreams  and  irritability. 
Cocaine,  441. 
Opii'm,  417.     A  drop  of  laudanum  with   two   of 

tinct.  nucis  vom.  three  or  four  times  a  day  for 

headaches  with  flushings  and  dyspepsia. 
Phosph.\te   of   lime,    156.      jNIay  be  combined 

with  phosphate  of  iron  and  carbonate  of  lime. 

A  grain  of  each  for  a  dose. 
Phosphorus,  235.     In  depression  from  overwork. 
Se.\-bathing,  38. 
SiTZ-B.\TH,  43.     For  ten  minutes  at  70°  to  80°  on 

return  from  business  tired  and  irritable.     Half 

hour  before  dinner. 


OXALURIA. 

Mineral  acids,  126.     When  eructations  of  sul- 
phuretted hydrogen. 


OZ.FINA. 

Acetate  of  alumina,  171.     Irrigation. 

Alum,  170,  171.  Nose  to  be  well  irrigated  with 
a  solution,  a  drachm  to  a  pint. 

Bismuth,  180.  With  equal  quantity  of  Venetian 
calc  in  chronic  non-syphilitic  oza:na  to  be 
snuffed  up  after  clearing  the  nose  by  strongly 
blowing  it.     Mercurial  powders  better. 

BoRO-GLVCERiDE,  133.     As  injection. 

C.-\RBOLic  acid,  258.  A  weak  solution  as  injec- 
tion. 

Glycerine  of  tannin,  171.     Irrigation. 

Iodine,  103.  Tinct.  chronic  with  solution  of 
common  salt. 

In  chronic  forms  nose  to  be  flushed  with 
solution  of  salt  containing  a  few  drops  tinct. 
iod. 

Iron,  173.  Spray  of  the  subsulphate  in  chronic 
form. 

Mercury,  197.  White  or  red  precipitate  with  58 
times  its  weight  of  sugar  snutfcd  up  after 
clearing  the  nose  in  the  non-syphilitic  form. 

— ,  197.  Ointment  of  the  nitrate  in  syphi- 
litic form.     (See  Syphilis.) 

S.ALOL,  453.     As  snuff. 

Tannin,  248.  Or  glycerine  of  tannin,  even  if 
syphilitic. 


INDEX    TO    DISEASES. 


509 


PAIN.     {See  Co  lie  ^  Gall-stones,  Neuralgia^ 
&^e.) 

Atropia,  388.     Hypodermically  in  local  pain,  in 

neuralgia,   sciatica,    glaucoma,  &c.      When   it 

succeeds,  effects   more   lasting   than    those  of 

morphia. 

Belladonna,  392.     Best  remedy  for  every  kind 

of  pain  in  pelvic  viscera  (Anstiei. 
Carbolic  acid,  257.     As  local  anaesthetic. 
Chloral,   285.      Sometimes   relieves   neuralgia, 
chronic    rheumatism,   gall-stones,    colic,    gas- 
tralgia,  and  even  cancer. 
Chlorofok.m,  269.     Locally,  generally  inferior  to 

other  anaesthetics, 
,  269.  Two  or  three  drops  on  cotton- 
wool introduced  into  the  ear  for  faceache  or 
toothache. 

Vapor  on  raw  surface  of  cancers,  neuralgia 
of  uterus,  a  photophobic  eye,  &c. 
,    271.      As  vapor  to  produce  gen- 
eral anaesthesia.     (See  ref.  for  full  directions.) 
,  270.     Inhalation  in  renal  and  bili- 
ary colic. 
CoNluM,  364.     In  cancer,  rheumatism,  neuralgia, 

&c. 
Ether,  278.     As  spray  for  local  anaesthesia,  also 
inhalation  to  produce  general  anaesthesia.     (See 
ref.) 
Iodoform,  279.     A  suppository  in  painful  diseases 

of  rectum  and  bladder. 
Mustard,  314.  For  localized  pain. 
Opium,  405.  Poultices  containing  laudanum 
used  in  inflammation.  Linim.  opii  rubbed  in 
relieves  neuralgias,  pleurodynia  and  myalgia  ; 
preparations  of  opium  or  morphia  are  applied  to 
irritable,  cancerous  and  simple  sores. 
,  406.  The  hypodermic  injection  of  mor- 
phia extensively  employed  to  relieve  pain.  The 
unpleasant  symptoms  often  accompanying  its 
administration  may  usually  be  obviated  by 
combining  it  with  a  twentieth  part  of  atropia. 
At  first  not  more  than  a  si.xth  of  a  grain  of 
morphia  should  be  injected.  A  single  injec- 
tion sometimes  cures  recent  and  even  long- 
standing sciatica  and  neuralgia.  Useful  in 
lumbago,  pleurodynia  and  toothache.  Oc- 
casionally required  in  pleurisy  or  pneumonia 
if  the  suffering  is  severe  or  persistent.  Valuable 
in  renal,  biliary  and  intestinal  colic. 

,     411.      An     injection  of   laudanum    and 

starch  useful  in  pain  of  bowels  or  organs  near 
the  rectum,  such  as  cystitis  or  uterine  diseases  ; 
opium  and  gall  ointment  excellent  for  painful 
bleeding  piles  and  fissures  of  anus. 

,  416.      In  chronic  cases  it  is  best    to  try 

first  all  other  methods  of  easing   pain,  as  an 
opiate  soon  loses  its  influence. 
Stramonium,  403.     As  ointment. 
W.\RM  injections.  76.    Soothe  the  pain  of  cystitis, 
prostatitis,  abscess  of  the  prostate  and  pelvic 
and  abdominal  pains  generally. 

PALPITATION. 

Aconite,  345. 

Camphor,  303.     In  nervous  palpitation. 
Eucalyptus,  309.     At  change  of  life. 
Hot  foot-bath,  52. 


PARALYSIS. 

Belladonna,  392.  When  depending  on  chronic 
inflammation  of  the  cord.  Brown-Sequard 
gave  ergot  internally,  applying  belladonna  as 
plaster  or  ointment  along  the  spine. 

Calabar  bean,  366.  In  general  paralysis  of  in- 
sane, also  in  progressive  muscular  wasting  with- 
out much  mental  disorder.  Also  in  some  cases 
of  long-standing  hemiplegia ;  sometimes  in 
paraplegia,  locomotor  ataxy,  and  writer's  cramp. 

Cannabis  indica,  429.  For  retention  of  urine 
from  spinal  disease. 


PARALYSIS — continued. 

Counter-irritation,  84.  By  blistering  fluid  in 
peripheral  paralysis  of  seventh  nerve. 

Ergot,  431.     Said  to  be  useful  in  paraplegia. 

Hvoscvamia,  401.  i-5oth  gr.  daily  hypodermic- 
ally,  or  i-5othgr.  night  and  morning  by  stomach 
in  paralysis  agitans.  But  symptoms  recur  on 
discontinuing  drug. 

HvosciN,  402.     In  paralysis  agitans. 

Nux  VOMICA,  423.  Or  strychnia  recommended  by 
Brown-Sequard  in  paraplegia  from  softening 
and  wasting  of  cord.  Often  useful  in  motor 
paralysis. 

Phosphorus,  235.     In  hysterical  paralysis. 

Strychnia,  419.     In  all  forms. 


PARONYCHIA. 

Mercury,  193.  As  ointment  applied  for  ten 
minutes  every  hour.     Poultices  at  other  times. 

Nitrate  of  lead,  193.  Dusted  on  diseased 
tissues  night  and  morning. 


PARTURITION.     {See  Cottfinement.) 
PEDICULI.     {See  Lice.) 

PEMPHIGUS. 

Arsenic,  227.  Largest  dose  five  min.  liq.  arsen- 
icalis  three  times  a  day,  not  on  empty  stomach. 
(See  ref.) 


PERICARDITIS. 

of.) 


{See   Heart,    diseases 


PERIOSTITIS.     {See  Nodes.) 

Iodide  of  potassium,  109,  no.  In  syphilitic 
children  ;  also  in  non-syphilitic  periosteal  thick- 
enings. 

Mercury  and  morphia,  oleate  op,  194. 
Locally. 


PERITONITIS.        {See    also    Puerperal 
Peritonitis.) 

Opium,  411.     To  quiet  intestinal  movements. 

Poultices,  64.  Large,  hot  and  frequently  re- 
newed. Should  be  thin  and  covered  with  cot- 
ton-wool. 


PERSPIRATION,  EXCESSIVE. 

Atropia,  374.  In  sweating  of  phthisis  and  ex- 
hausting diseases.     (See  Phthisis.) 

Belladonna,  383.  As  liniment  locally  to  affected 
part',  also  tincture  internally,  especially  in 
weakly  children  who  perspire  profusely.  Also 
very  useful  where  the  perspiration  has  cau-ed 
the  skin  of  the  feet  to  peel  off,  leaving  the  der- 
mis red  and  tender. 

Ergot,  431.     Said  to  arrest  sweating. 

Hyoscin,  403.     Checks  the  sweating  of  phthisis. 

Iodoform,  280.     Diminishes  phthisis. 

Lead,  182.  As  ointment  of  equal  parts  of  emp. 
plumb,  and  linseed  oil  spread  on  linen  and 
wrapped  round  the  feet  when  they  sweat — to  be 
renewed  every  third  day  for  nine  days. 

Oils,  238.  Rubbed  into  the  whole  skin  to  pre- 
vent sweating  accompanying  exhausting  dis- 
eases, as  phthisis ;  but  sponging  with  a  weak 
acid  wash  better. 

Opium,  374,  417.  As  Dover's  powder  may  suc- 
ceed after  zinc  has  failed. 


510 


INDEX    TO    DISEASES. 


FERSFIRAT  ION— continued. 

PiCROTOXiNE,  374,  375.     In     1     gr.  doses. 
Pilocarpine,  374.     In    1    gr.  doses  thrice  daily. 
QuiiNiA,  447.     In  exhausting  diseases,  as  chronic 

phthisis.     If  a   small  dose    fail,  one  of  six    or 

eight  grs.  at  once  or  in  portions  repeated  hourly. 
In   many  cases   a  night  draught   of   quinia, 

sulphate  of  zinc,  and  sulphuric  acid  very  useful. 

• ,  442.     Z  )■  in  (Jj.  alcohol  for  bathing  skin. 

Spinal  ice-bag,  70. 

Sponging,  very  hot,  52.     In  phthisis. 

Sponging  with  acidulated  water,  124. 

Tannin  or  gallic  acid,  250. 

Zinc,  oxide  of,  210.     In  two-grain  doses  nightly 

to  control  profuse  colliquative  sweating. 


PHARYNGITIS.     (See  Throat,  Sore.) 


PHLEBITIS. 

A  BLISTER,  82.     Over  course  of  inflamed  super- 
ficial vein. 


PHLEGMASIA  DOLENS. 

Ha.mamelis,  252. 

PHOTOPHOBIA.     {See  Eye,  diseases  of; 
also  Conjunctivitis.) 

PHTHIRIASIS.     {See  Lice.) 


PHTHISIS. 

dj'c.) 


(See    Cough.,    Hemoptysis, 


Brandy  and  milk  before  break- 


ACT.«A,  338 
Alcohol,  26 

fast. 
Arsenic,  3.     When  red,  smooth,  clean  "  irritable" 

tongue. 

216.     As  cigarettes — caution  required. 

Useful  in  the  diarrhoea. 
Probably  diminishes  temperature. 
i-2ooth  to  i-iooth  hypodermically, 
or  i-7oth  to  i-5oth,  or  even,  in  exceptional  cases, 
i-2oth  in  pill,  to  check  excessive  perspiration. 

Belladonna,  383.  Liniment  or  plaster  for 
hypersensitiveness  of  the  muscles  of  the 
chest. 

Benzoic  acid,  307.     As  inhalation. 

Blisters,  83.     In  chronic  or  fibroid  phthisis. 

Brandy,  268.     Or  rum  and  milk  before  breakfast. 

Chloride  of  calcium,  154.  Recommended  as 
inhalation. 

Chloroform,  270.  With  glycerine  or  honey  for 
the  cough  in  fibroid  phthisis. 

CoD-LivF-R  oil,  242.  Very  valuable  in  nearly  all 
forms  of  this  disease,  especially  at  commence- 
ment.    (See  ref.) 

Coto-bark,  253.  To  check  sweating.  Also  as- 
serted to  be  useful  in  diarrhoea. 

Counter-irritation,  82,  83.  Only  to  relieve 
pain  in  acute  forms,  as  iodine  liniment ;  quiets 
cough  and  diminishes  expectoration  in  chronic 
or  fibroid  phthisis. 

Creasote,  256.  Tar,  or  carbolic  acid  to  check 
expectoration.  In  full  doses  in  non-febrile 
cases  increases  appetite. 

Croton  oil,  244,  245.  With  or  without  liq.  po- 
tassae  as  counter-irritant  to  chest.  Caution 
must  be  used. 

Enemata,  411.  Of  starch  and  laudanum  for  the 
diarrhoea. 


VllT\l\?>l'i— continued. 

Eucalyptus,  309.  Twenty  drops  of,  inhaled  for 
cough  of  chronic  phthisis. 

Gelsemium,  379.     For  the  cough. 

Glycerine,  247.  In  last  stage  with  water  as 
wash  for  dry  shiny  mouth. 

,  248.     t  or  cough. 

Hypophosphites,  158.  Of  lime  or  soda, — should 
be  given  alone.  Most  useful  m  early  stage 
and  in  young  subjects. 

Iodine,  100.  As  liniment  painted  under  clavicles 
in  chronic  forms  to  allay  harassing  cough  and 
to  check  secretion. 

,  102.     As  inhalation  in  chronic  phthisis  to 

lessen  expectoration  and  cough. 

Iodoform,  280.  In  turpentine  as  spray.  Also 
given  internally. 

,280.    With  spirits  of  turpentine.    Also 

given  internally  with  extract  of  gentian. 

Ipecacu.\nha,  323.  Spray  to  throat  when  bron- 
chial asthma  and  emphysema  combined  with 
fibroid  phthisis. 

Mercury,  202.  The  hundredth  of  a  grain  of 
corrosive  sublimate  every  two  or  three  hours  in 
diarrhoea 

Opium,  409.  Or  morphia  in  a  viscid  vehicle  for 
cough,  especially  where  this  is  due  to  inflamed 
condition  of  throat — morphia  lozenges  very 
useful  here. 

,^l^.     As  Dover's  powder  for  night  sweats. 

Phosphate  of  lime,  156.     In  diarrhoea. 

,  136.     In  chronic  forms  of 

phthisis  with  little  or  no  fever. 

Picrotoxine,  374.     (See  Perspiration,  excessive.) 

Pilocarpine,  374.     (See  Perspiration,  excessive.) 

Quinia,  446.  In  acute  phthisis  to  reduce  temper- 
ature. 

,  447.  In  chronic  phthisis  to  check  sweat- 
ing. If  a  small  dose  fail,  a  dose  of  six  or  eight 
grs.  administered  at  once  or  in  portions  re- 
peated hourly. 

S.vLiCYLic  acid,  452.  In  five-gr.  doses  for  foul 
breath  and  offensive  expectoration. 

S.^LOL,  453. 

Sea-b.\thing,  43.  If  chronic,  little  or  no  fever, 
without  active  deposition  of  tubercle  or  scrofu- 
lous pneumonia. 

SiLVEK,   nitrate   OF,    189. 

into  trachea.     (See  ref.) 

Sponging,  very     hot,  52. 
spiration. 

Sulphides,  94.     As  natural  water. 

Sulphurettkd  hydrogen,  94.  Intestinal  injec- 
tion of,  mixed  with  carbonic  acid  gas. 

Sulphuric  acid,  129.  With  sulph.  zinc,  to  check 
perspiration. 

Sulphurous  acid,  131.  Inhalation,  spray  or 
fumigation  in  chronic  phthisis. 

Turkish  baths,  59.     For  the  cough. 

Vinegar,  129.    With  laurel  water  to  check  sweats. 


PILES. 

Aloes,  458.     To  gently  relieve  bowels. 

Bro.mide  of  potassium,  114.  In  five  parts  glyc- 
erine locally  to  ease  pain. 

Calomel,  251.     As  ointment. 

Castor  oil,  246. 

Chlorate  of  potash,  169.  ^^s.  to  5  J-  of  satu- 
rated solution  with  five  to  ten  drops  of  lauda- 
num as  injection  when  inflamed  and  painful. 

Cold  injection,  58.  Half  a  pint  before  going 
to  stool  every  morning. 

Gallic  .^cid,  251.     With  opium  as  ointment. 

Ha.mamelis,  252.  As  lotion  or  injection  as  well 
as  by  mouth  in  piles,  whether  bleeding  or  not. 

Ice,  67.     Locally  applied  for  pain  after  operation. 

Le.\d,  182.     As  plaster  for  pain  in    back  due  to 

Nitric  acid,  128.  Strong,  applied  to  internal 
piles,  also  to  granular  or  ulcerated  piles.  Half- 
ounce  or  one  ounce  to  half  a  pint  of  water  as 
lotion  for  bleeding  piles. 


Sometimes   injected 
For   excessive   per- 


INDEX    TO    DISEASES. 


511 


PILES — continued. 

Opium,  411.  Mixed  with  gall  ointment,  an  ex- 
cellent application  for  painful  bleeding  piles. 
Mild  purgatives  also  required. 

Rhubarb,  462.  About  ten  grs.  of  the  root  to  be 
chewed  nightly  if  a  laxative  is  needed. 

Useful    also   in   haemorrhoidal    swellings  of 
pregnancy. 

Sulphur,  91.  Five  to  ten  grs.  with  one  drachm 
conf .  senn.  in  the  morning  as  a  laxative. 


PITYRIASIS. 

Borax,  135.  Saturated  solution  locally  several 
times  a  day  in  pityriasis  of  scalp.  If  not  suc- 
cessful try  it  as  glycerine  of  borax. 

Glycerine  of  borax,  247.    In  pityriasis  of  scalp. 

Lead,  182.  Liq.  plumb,  two  ozs.,  glycerine  two 
ozs.,  to  four  ozs,  of  water  as  lotion. 

Mercury,  192,  193.  Citrine  ointment  especially 
when  pityriasis  of  hairy  parts  of  face.  Often 
well  to  add  tar  ointment. 

Sulphurous  acid,  131.  With  glycerine  in  con- 
junction with  warm  baths. 


PITYRIASIS  VERSICOLOR. 

Mercury,  193.  The  bichloride  in  solution  two 
grs.  to  the  oz.  of  water  as  a  lotion. 

Mercury,  194.  The  oleate  of  mercury  with  ether 
applied  with  a  camel-hair  pencil. 

Sulphurous  acid,  131.  The  B.  P.  acid  with 
glycerine;  warm  baths  should  also  be  employed. 


PLEURISY. 

Aconite,  342.     Has  marked  effect. 

Antimony,  213.  As  tartar-emetic.  (See  Inflam- 
mation.) 

Blisters,  82.  Large  and  flying  after  subsidence 
of  inflammation  and  fever,  to  further  absorption 
of  the  fluid.  The  vesication,  if  any,  should  be 
healed  at  once. 

CoD-LiVER  oil,  242.     In  chronic  form. 

Iodide  of  potassium,  hi.  To  quicken  absorp- 
tion of  inflammatory  effusions. 

Iodine,  100.  As  liniment  to  chest  to  promote 
absorption. 

,   102.      Solution  (weak  at  first)  injected, 

after  tapping  the  injection, — may  contain  other 
disinfectants. 

MoRPHi.\  injection,  407.  Occasionally  needed 
for  severe  pain. 

Mustard,  314.     To  affected  organs  in  pleurisy. 

Packing,  44. 

Pilocarpine,  374.     To  remove  effusion. 

Potash,  142.  As  liquor  potassae  is  occasionally 
employed  in  pleurisy  to  promote  the  absorption 
of  the  inflammatory  formations,  but  it  is  unad- 
visable  to  use  it  long. 

Poultices,  63.  Large,  hot,  and  frequently  re- 
newed. 

Purgative  salts,  163,  164.  3  vj.-5J-  sulph. 
magnes.  in  5  J-  water  before  food. 

Sin.\pisms,  314.     Large. 

Veratrum  viride,  328.  Opinions  differ  as  to 
whether  it  should  be  used  in  sthenic  or  asthenic 
forms. 


PLEURODYNIA. 

AcT/EA  RACEMOSA,  337.    When  pleurodynia  due 

to  uterine  derangements. 
AcupuNCTiRK,  79.     At  "  corresponding  spot  "  on 

opposite  side. 
Belladonna,  64,  383.     Generally  liniment  best, 

sometimes  the  plaster  better. 
Blistering,  85.      Sometimes  strong  vesication 

necessary. 


PLEURODYNIA— r^«/e««^a'. 

Chloral,  285.  Made  liquid  with  equal  weight 
of  camphor,  and  rubbed  gently  in. 

Ether,  64.  As  spray  sometimes  immediately 
and  permanently  removes  pain. 

Iodine,  103.     As  a  liniment. 

Mustard,  100.     As  poultice. 

Opium,  405.  The  liniment  may  be  rubbed  in,  or 
sometimes  a  hypodermic  injection  of  morphia 
may  be  necessary. 

Poultices,  64.  Very  hot ;  followed  by  applica- 
tion of  lint  and  oilskin  ;  belladonna  liniment 
generally  better. 


PNEUMONIA. 

Aconite,  342.     Has  marked  effect. 

Antimony,  15.  Small  frequent  doses  of  tartar- 
emetic  when  skin  hot  and  dry — better  here  than 
aconite. 

,  214.     At  commencement.     If  patient 

weak,  must  take  alcoholic  stimulants  as  well. 

Blisters,  82.  Lessen  the  pain  ;  should  be  used 
m  moderation. 

Ether,  278.  In  adynamic  pneumonia  hypoder- 
mically. 

Morphia  injection,  407.  Sometimes  needed  for 
severe  pain. 

Must.\rd;  314.     To  affected  organs. 

Packing,  45.  Some  pack  the  chest  only,  renew- 
ing hourly. 

Phosphorus,  235.  Especially  when  typhoid 
symptoms. 

Poultices,  63,  64.  Large  and  hot.  To  encircle 
whole  chest  in  children. 

Quinia,  446.     To  reduce  temperature. 

Sinapisms,  314.     Large. 

Veratrum  viride,  328.  Opinions  differ  as  to 
whether  it  should  be  used  in  sthenic  or  asthenic 
forms. 


POISONING   GENERALLY. 

Apomorphia,  327.      Hypodermically,  Ji  gr.,  to 

produce  prompt  emesis. 
Sulphate  of  zinc,  208,  209.     The  best  emetic. 


POISONING  BY  ACIDS. 

Alkalies,  139.     The  least  irritating  to  the  stom- 
ach to  be  selected. 
Magnesia,  oxide  of,  150. 


POISONING  BY  ALCOHOL. 

Cold  douche,  56,  57.    Poured  for  some  time  from 

a  height  on  to  the  head. 
Cold  water,  37.     Smartly  sprinkled  on  face. 
Maintenance  of  temperature,  37. 


POISONING  BY  ALKALIES. 
Acids,  127.     Dilute. 

POISONING  BY   ANTIMONY. 

Alkalies,  138,  139. 

Tannin,  250.     Or  strong  tea  or  coffee. 

POISONING  BY  ARSENIC. 

Bicarbonate  of  magnesia,  139.     Or  other  al- 
kalies. 
Charcoal,  87.     Half  an  ounce  or  more. 
Oxide  of  magnesia,  150. 


512 


INDEX    TO    DISEASES. 


POISONING  BY  BELLADONNA  OR 
ATROPL^. 

Alkalies,  139.     Especially  bicarb,  of  magnesia 

in  poisoning  by  alkaloids. 
Ammonia,  :48.     Breathed  into  air  passages. 
Charcoal,  87.  In  poisoning  by  belladonna.  Half 

an  ounce  or  more  must  be  given. 
Lime-water,  399.     Has  been  recommended. 
Physostigma,  397.     Doubtful. 


POISONING  BY  CHLORAL. 

Maintenance  of  temperature,  37. 
Physostigma,  367. 

Strychnia,   286.        The    antidote   according  to 
Liebreich. 


POISONING  BY  LEAD. 

Alkalies,  139.  Especially  bicarbonate  of  mag- 
nesia in  poisoning  by  metallic  salts. 

Iodide  OF    potassiu.m,  iii.     I n  chronic  cases. 

Lukewarm  drinks,  183.  Or  sulphate  of  soda, 
.sulphate  of  magnesia,  or  freshly  precipitated 
sulphide  of  iron  ;  promote  vomiting — use  stom- 
ach-pump— give  milk  with  white  of  egg  in  acute 
lea  d  po  {son  ing. 

Sulphides,  93.     As  baths  in  chronic  form. 


POISONING  BY  MERCURY. 

Alkalies,  139.     Bicarbonate  of  magnesia  best. 
Baths,  203.     Simple  or  sulphurous. 
Charcoal,  87.     In  poisoning  by  corrosive  subli- 
mate, half  an  ounce  or  more  must  be  given. 


POISONING  BY  NITRATE  OF   SIL- 
VER. 

Alkalies,  139.      Especially  the   bicarbonate   of 

magnesia. 
Chloride  of  sodium,  159. 


POISONING    BY   OPIUM    OR   MOR- 
PHIA. 

Ammonia,  148.     Breathed  into  air  passages. 

Atropia,  395.  Quarter  to  half  a  grain  hypoder- 
mically. 

Bicarbonate  of  magnesia,  139. 

Bromide  of  pot.assium,  120.  Controls  disagree- 
able effects  of  medicinal  doses  of  opium  ;  20 
grains  an  hour  before,  and  the  same  dose  two 
hours  after,  the  opiate. 

Charcoal,  87.     Half  an  ounce  or  more. 

Cocaine,  440.     Internally. 

Cold  douche,  56,  57.  Poured  for  some  time 
from  a  height  on  the  head. 

Cold  water,  37.     Smartly  sprinkled  on  face. 

Stomach  pump,  183,  413.  Rouse  patient,  keep 
him  constantly  moving  to  prevent  sleep,  give 
strong  coffee,  apply  cold  affusion  to  head,  and 
if  necessary  adopt  artificial  respiration. 


POISONING  BY  OXALIC  ACID. 

Lime,  153.     Salts  of. 
Oxide  of  magnesia,  150. 


POISONING  BY  PHOSPHORUS. 

Copper    salts,    236.       Better   than    turpentine. 

Repeat  till  vomiting. 
Transfusion,  233. 
Turpentine,  305. 


POISONING  BY  PHYSOSTIGMA. 

Atropia,  396.  One-fiftieth  to  one-thirtieth  of  a 
grain  hypodermically,  repeated  till  effects  evi- 
dent. 

Chloral,  286.     The  antidote. 


POISONING  BY  PICROTOXINE. 

Chloral,  286.     The  antidote. 

POISONING  BY  SALTS  OF  POTAS- 
SIUM, SODIUM,  AND  AMMO- 
NIUM. 

Rffect  depends  tnainly  on  percentage  dose.    (See 

P-  105.) 
Bleeding,  105. 
Drinking  freely,  105.     To  dilute  blood. 

POISONING  BY  STRYCHNIA. 

Alkaline  bicarbon.^tes,  139.     Magnesia  best. 

Calabar  be.\n,  366.     As  an  antidote. 

Charcoal,  87.     Half  an  ounce  or  more. 

Chloral,  286.     The  antidote. 

Nitrite  of  amyl,  295.     Inhalation. 

Stom.\ch  pump,  422.  If  available  before  tetanic 
symptoms,  animal  charcoal^  tannin  solution 
of  iodine,  chloroform  inhalation^  injection  of 
curare,  or  of  methyl  and  ethyl  compound  of 
strychnia,  of  brucia,  or  of  thebaia,  artificial 
respiration,  fats. 


PREGNANCY.     {See  Vomiting.) 

AcT.*:.^,  337.  To  prevent  miscarriages  in  irritable 
or  prolapsed  uterus. 

Bromide  of  potassium,  119.  For  frightful  de- 
lusions in  later  months. 

Cocaine,  441.     Internally  in  vomiting. 

Ipecacuanha,  126.     Sometimes  for  acidity. 

Sea-b.-\thing,  39.  In  earlier  months,  unless 
there  have  been  several  miscarriages  or  the  pa- 
tient is  of  very  excitable  temperament. 


PROLAPSUS. 

Alum,  170.  In  solution,  six  grains  to  the  ounce, 
in  prolapsus  ani  and  uteri. 

Ergotin,  431.     Injections  in  prolapsus  of  rectum. 

Ice,  68.  Locally  applied  in  prolapsus  of  rectum 
or  uterus  when  parts  inflamed. 

Nux  vomica,  126.  For  acidity  two  or  three 
drops. 

Strvchni.\,  424.  In  prolapsus  ani,  especially  in 
children.  If  there  is  constipation  nu.\  vomica 
may  be  added  to  a  purgative,  as  tincture  of 
rhubarb.  If  there  is  diarrhoea  it  should  be 
checked. 

Sulphur,  91.  In  prolapsus  recti  has  a  beneficial 
effect  in  addition  to  that  due  to  laxative  prop- 
erties. 

Tannin,  250.  As  catechu,  kino,  red  gum,  rha- 
tany  ;  haematoxylum  injections  to  restrain  pro- 
lapsus ani. 


PROSTATITIS. 

Cantharides,  313.     A  drop  of  the  tincture  (five 

may  be  required)  three  or  four  times  a  day. 
Hot  injections,  76.     To  relieve  pain. 


PRURIGO. 

Borax,  137.     (See  Pruritus.) 
Cantharides,  311.     Internally. 


INDEX    TO    DISEASES. 


513 


VRVRIGO— continued. 

Carbolic  acid,   257.      Oil  of  cade,    &c.      (See 

Pruritus.) 
Chloroform,  269.     As  ointment  to  allay  itching. 
Cyanide  of   potassium,   404.      Or  hydrocyanic 

acid.     (See  Pruritus.) 
Ice,  67.     For  prurigo  of  vulva. 
Iodoform,  279.     As   ointment.     One  drachm  to 

the  ounce. 
Sui.i'HUK,  90.     With  tar  and   benzoated  lard   as 

ointment  in  genuine  prurigo. 
Turkish    bath,  61.      When    unconnected   with 

lice. 

W.ARM    BATHS,  SI,  52. 


PRURITUS. 

Alkalies,  134.     An  alkaline  solution  such  as  a 
drachm  of  carbonate  of   potash  or  soda   to   a 
pint   of   water  applied  with   a  small   piece   of 
sponge  in  itching  of  urticaria  or  lichen.     Solu- 
tion of  cyanide   of   potassium,  same   strength, 
better  still. 
Alum,  171.    A  strong  solution  for  pruritus  vulvae. 
Arsenic,  217.    In  itching  of  the  nose  accompany- 
ing asthma-like  affections.     (See  Asthma.) 
Benzoin,  307.     The  comp.  tinct.  painted  on  the 

skin  in  eczema,  urticaria,  &c. 
BoRACic   acid,  133.      As  lotion  in   pruritus  pu- 
dendi. 

,  137.     A  teaspoonful  dissolved  in 

a  pint  of  boiling  water,  used  tepid  or  cold  as 
lotion  in  pruritus  pudendi. 
Borax,  137.  Five  to  ten  grains  to  the  ounce  of 
hot  water  in  pruriginous  eruption  on  mucous 
membrane  of  vulva  and  vagina.  In  this  com- 
plaint '.nfusion  of  tobacco,  iodide  of  lead  as 
ointment,  bismuth  and  morphia  as  ointment, 
chloroform  as  vapor,  liniment  or  ointment  ;  lead 
lotion  ;  nitrate  of  silver  ;  alum  in  solution,  tan- 
nin in  solution,  are  often  useful,  especially 
when  alternated. 
Camphor,  301.  An  addition  to  dusting  powders 
to  allay  heat  and  itching  of  eczema  and  inter- 
trigo. 
Carbolic  acid,  257.  Solution  as  topical  applica- 
tion, even  when  itchint  due  to  jaundice. 

,  254.     In  chronic  eczema,  psoriasis 

and  erythema,  or,  better  still,  liquid   carbonas 
detergens,  oil  of  cade,  or  oleum  rusci. 

;  258.     A  weak  lotion  (i  in  100)  in 

pruritus  ani  and  pudendi. 
Chloroform,  269.     As  ointment  to  allay  itching 

of  skin  diseases. 
Chro.mic  acid,  137. 

Cocaine,  441.     Lotions  in  pruritus  ani  and    pu- 
dendi. 
Cold  .\nal  douche,  58. 

Cyanide  of  potassium,  404.  A  drachm  in  a 
pint  of  water  as  lotion  for  urticaria,  lichen, 
eczema,  and  prurigo  where  the  skin  is  unbroken. 
Hydrocyanic  acid,  404.  Thirty  drops  of  B.  P. 
acid  in  one  ounce  of  water  or  glycerine  may  be 
used  instead  of  the  cyanide  of  potassium  solu- 
tion. 
Iodine,  103.     In   itching  of   the   nose   or  inner 

canthus. 
Lead,  182.     Lotions  ease  itching  of  urticaria.     A 
strong   lotion   useful   in   pruritus   pudendi,  es- 
pecially where  mucous  membrane  red  and  ex- 
coriated.    If   this   is   dependent  on   worms   or 
tumor,  lotion  useless. 
Menthol,  307.     Ointment  in  pruritus  ani. 
Mercury,  191.     Strong  solutions  of   bichloride, 
black  wash,  yellow  wash  or  mercurial  ointment 
in  itching  of  skin  affections. 

An  ointment  of  a  drachm  of  calomel  to  one 
oz.  of  lard  is  best,  not  however  in  urticaria. 

Calomel  ointment  useful  in  pruritus  ani,  but 
less  so  in  pruritus  pudendi.  In  obstinate  cases 
of  these,  blisters  to  thighs  or  leeches  useful. 

Calomel  ointment  useful  in  itchy  scabbiness 
of  scalp  and  in  pityriasis  of  scalp. 

33 


PR  U  R I T  U  S— continued. 

Nitrate  of  mercury  ointment  will  destroy 
lice. 

Salicylic  acid,  452.  As  ointment  in  pruritus 
ani  and  vulvae. 

Silver,  nitrate  of,  188.  To  be  painted  every 
day  or  second  day  on  a  patch  of  lichen  the  size 
of  the  palm  causing  excessive  irritation.  A 
weak  solution  often  relieves  pruritus  ani  and 
pudendi ;  apply  well  with  camel-hair  brush 
three  or  four  times  a  day. 

A  strong  solution  in  pruritus  cutaneus  of  the 
meatus  auditorius  without  eruption  on  skin  ; 
the  memb.  tymp.  to  be  carefully  avoided.  If 
itching  from  dryness  of  ear  or  deficient  secre- 
tion of  wax,  try  first  almond  oil  or  glycerine. 

PSORIASIS. 

Arsenic,  227.  At  first  apparently  aggravates 
the  disease  but  soon  heals  it.  Largest  dose 
required  five  min.  liq.  arsen.  three  times  a  day 
— never  on  empty  stomach.  For  rules  for  giv- 
ing arsenic,  see  ref. 

Calomel  ointment,  191. 

Cantharides,  311.     Internally. 

Carbolic  acid,  254.  Or,  better  still,  liquor  car- 
bonas detergens,  oil  of  cade,  oleum  rusci. 

Copper,  sulphate  of,  206.  Applied  solid  to 
spots  of  psoriasis,  simple  or  specific. 

Mercury,  192.  Calomel  and  nitrate  of  mercury 
ointment  may  be  mixed,  and  tar  ointment  may 
be  added,  in  patches  of  obstinate  psoriasis,  es- 
pecially of  hands,  even  when  not  syphilitic. 

Oils  and  fats,  238.  To  lubricate  skin,  used  in 
conjunction  with  warm  baths. 

Silver,  nitrate  of,  188.  Or  sulphate  of  copper. 
An  occasional  application  useful  in  psoriasis  of 
the  tongue  and  mucous  membrane  of  mouth. 
If  these  are  syphilitic,  mercurials  best. 

So.AP,  134.     Assists  removal  of  scales. 

Sulphides,  93.     In  baths— not  in  acute  stage. 

Sulphur,  92.     Internally. 

Tar,  254.  In  obstinate  forms  may  be  painted  on 
the  patches  and  left  on,  or  creasote  ointment, 
petroleum,  cade,  and  carbolic  soaps  of  various 
strengths  useful. 

Turkish  bath,  59. 

Vaseline,  253.     Locally. 

Warm  bath,  51.  Especially  in  acute  stage,  rain 
or  boiled  water. 


PUERPERAL  FEVER,  ETC. 

Antimony,  214.  As  tartar-emetic  for  mania,  but 
bromide  and  chloral  better. 

Bromide  of  potassium,  nq.     For  mania. 

Chloral,  283.     For  mania  and  convulsions. 

Morphia,  408.  Hypodermically,  sometimes  ar- 
rests puerperal  convulsions. 

Permanganate,  178.     Has  been  given  internally. 

Turpentine,  305.     Has  been  used. 

PUERPERAL  PERITONITIS. 

Antimony,  213.  As  tartar-emetic.  (See  also 
Inflammation.) 

Chlorine  solution,  99.  For  washing  out  va- 
gina. 

PURPURA. 

Arsenic,  109.     When  due  to  iodism. 

Ergot,  430.     Has  been  strongly  recommended. 

Turpentine,  305.     Has  been  used. 

PYEMIA  AND  SEPTICEMIA. 

Ammonium  carbonate,  149.     In  typhoid  condi- 
tion. 
Perm.\nganate,  178.    Has  been  given  internally. 
QuiNiA,  446.     Supposed  to  diminish  temperature. 


514 


INDEX    TO    DISEASES. 


PYROSIS. 

Bismuth,  i8o.  Useful  in  the  various  forms, 
whether  acid,  alkaline  or  neutral. 

Lead,  182.  Soluble  preparations  are  recom- 
mended. 

Mang.\nese,  178.     Black  oxide. 

Nitric  acid,  125.  Or  hydrochloric  acid  in  small 
medicinal  doses  shortly  before  meals  when 
pyrosis  acid, — after  when  pyrosis  alkaline. 

Sulphurous  acid,  131. 


QUINSY.      {See  Throat,  diseases  of.) 


RECTUM,  DISEASES  OF. 

Bromide  of  potassium,  114.  Locally  in  five 
parts  glycerine  in  fissures  of  rectum  and  pain- 
ful growths. 

Cocaine,  440.  Suppositories  and  pessaries  in 
painful  conditions. 

Iodofor.m,  279.  As  suppository  in  painful  dis- 
eases. 

Phosphorus,  235.     In  chronic  inflammation. 


RENAL  COLIC.     {See  Colic.) 


RESTLESSNESS. 

Aconite,  345.     One  drop  of  tincture  at  bed-time, 

repeated  if  needful. 
Warm  sponging,  51.     To  induce  sleep  and  calm 

restlessness  of  convalescence. 


RETENTION  OF  URINE. 

Cannabis  indica,  429.     When  from  spinal  disease. 

RHEUMATISM,  ACUTE. 

Acid  steam-bath,  62.  Relieves  pain  and  checks 
perspiration. 

Aconite,  344.  Often  subdues  pain  in  inflamed 
joints  and  perhaps  shortens  the  fever. 

AcTAi.K  racemosa,  337.  Has  been  much  used, 
said  to  quell  the  pain  speedily. 

Acupuncture,  79.  At  "  corresponding  spot  "  on 
opposite  side  to  relieve  pain. 

Antipvrine,  454.  Cannot  compare  with  salicy- 
late. 

Benzoic  acid,  308.     Inferior  to  salicylic  acid. 

Bicarbonate  or  citrate  ok  potash,  141.  Opin- 
ions very  divergent.  Seems,  however,  to  re- 
lieve pain. 

Blistering,  84.  Large  flying  blisters  to  inflamed 
joint. 

Cold-water  treatment,  48.  Invaluable  in 
hyperpyrexia.     (See  p.  49.) 

Cold  wet  compress,  45.     To  painful  joints. 

Coniu.m,  364.     Internally  to  relieve  pain. 

Li.ME-juiCE,  129.  Eight  ozs.  daily  ;  lemon-juice 
inferior. 

NiTR.\TE  OF  potash,  167.  In  large  doses  (half 
oz.  to  one  oz.  in  the  day)  freely  diluted  in 
water  or  lemonade — thought  highly  of  by  some. 

Opium,  416.  Hypodermically  to  relieve  pain  and 
induce  sleep. 

Packing,  45.  If  patient  cannot  be  moved  front 
of  body  may  be  packed. 

Poultices,  64.     Very  hot  on  the  painful  part. 

QuiNiA,  447.     Recommended  by  some  (see  ref.) 

Salicine,  449,  450.  Thirty  grains  every  two 
hours  or  even  hourly  at  first.  Improvement 
goierally  in  one  or  two  days,  and  course  of 
fever  much  shortened.  Mitigation  of  pain  first 
sign  of  improvement.     Liable  to  relapse. 

S.^licvl.^te  of  soda,  451.  Behaves  as  salicine. 
Also  used  locally  to  joints. 


RHEUMATISM,  AC\ji:'E—contimied. 

S.\LiCYLic  acid.  451.  Behaves  as  salicine,  but  is 
very  slightly  soluble  and  liable  to  impurities. 

Salol,  453. 

Sulphurous  acid,  131.  After  fumigation,  patient 
to  be  covered  with  bed-clothes  which  have  been 
exposed  to  strong  fumes  ;  this  produces  perspi- 
ration, sleep  and  relief. 

Tepid  or  cold  sponging,  45.  If  prejudiced 
against  packing. 

Turkish  bath,  60.     For  modified  form,  see  p.  62. 

Veratria,  329.  Veratrum  viride  as  tinct.  is  said 
to  be  useful. 

— — ,  330.    As  ointment  to  rheumatic  joints. 

It  often,  however,  fails. 


RHEUMATISM,  CHRONIC. 

Antipvrine,  454.     Hypodeimically. 

Blistering,  85.     Nightly  in  gonorrhoea!  form. 

Brine  baths,  52.  At  Droitwich.also  home  baths. 

Capsicu.m,  316.  A  strong  infusion  applied  on  lint 
for  rheumatic  pains. 

Carbonic  acid,  8S.  Natural  waters  containing 
much  carbonic  acid  used  externally. 

Chloral,  285.     Often  relieves  the  pain. 

Cod-liver  oil,  243. 

Cold  douche,  57.     Salt  may  be  added. 

Galvanism,  61.     For  pain  and  stiffness. 

,  64.     For  pains  remaining  after  acute 

rheumatism. 

Guaiacum,  336. 

Ice  and  s.\lt,  68.  Apply  for  six  minutes  to  dis- 
eased joints,  then  replace  for  short  time  by 
pounded  ice. 

Iodide  of  pot.assium,  hi.  Especially  when  pain 
worse  at  night,  or  of  syphilitic  origin. 

Iodine,  100.     Paint  round  joints. 

La.mp-bath,  61. 

Mercury  and  morphi.\,  oleate  of,  194.  For 
joint  affections  (locally). 

Nitrate  of  potash,  167.  Ten  grains  hourly  or 
every  two  hours  when  urine  scanty  and  high- 
colored,  becoming  turbid  on  cooling. 

Oil  of  mezereon,  307.  And  of  sassafras  reported 
useful. 

Packing,  44. 

Poultices,  64.  In  so-called  rheumatic  pains  at- 
tacking one  part  of  the  body. 

S.\LOL,  453. 

Sulphides,  93.     As  baths. 

Sulphur,  92.  Locally  applied.  Internally  in 
chronic  and  muscular  rheumatism, 

Turkish  baths,  60.  Generally  and  for  circum- 
scribed stiffness  in  shoulder. 

Hot  followed  by  cold  sponging  may  be  used 
as  substitute. 

Veratria,  330.  As  ointment  to  rheumatic  joints  ; 
often  fails. 


RHEUMATOID  ARTHRITIS. 

AcT.«;.A  RACEMOSA,  337.  Especially  when  con- 
nected with  uterine  derangement — also  in  other 
cases  (see  ref.). 

Arsenic,  216.  .As  a  bath  containing  four  ozs. 
washing  soda  and  twenty  grs.  arseniate  of  soda. 

,  230.     Large  doses  continued  for  some 

time  sometimes  of  great  benefit,  but  action 
capricious. 

Bro.mide  of  potassium,  120.  Sometimes  allays 
the  severe  pain. 

Cod-liver  oil,  243. 

Cold  douche,  58.  May  be  slightly  warmed  in 
winter,  use  for  one  or  two  minutes  and  rub  dry. 

Iodide  of  potassiu.m,  hi.  Sometimes  large 
doses  required  (seep.  113.) 

Iodine,  104.  Tinct.  internally  said  to  be  better 
than  pot.  iod. 

Sulphides,  93.     In  baths. 

Turkish  e.aths,  61. 


J 


INDEX    TO    DISEASES. 


515 


RICKETS. 

Cod-l:ver  oil,  243. 

Cold  sfonglng,  55.     If  the  child  is  weak  or  very 

impressionable  he  should  be  allowed  to  stand 

up   to  the  ankles  in  warm  water  before  a  fire 

while  Deing  sponged. 
Iron,  176.     Must  be  continued  along  time. 
Lime,  154.     As  lime-water  or  carbonate  of  lime. 
Pho.sphate  of  lime,  156.     Small  doses  as  good 

as  large. 


RINGWORM.     {See  Tmea.) 


SALIVATION. 

Acids,  124.  As  astringents  in  salivation.  Small 
medicinal  doses. 

Alcohol,  262.     Diluted,  as  gargle. 

Atkopia,  387.     Hypodermically. 

Bromide  of  potassium,  117.  For  salivation  of 
pregnancy. 

Chlorate  of  potash,  168,  Whether  mercurial 
or  simple  salivation. 

Chlorine  solution,  99. 

Goto  bark,  253. 

HvosciN,  402. 

Iodide  of  potassium,  110.  Sometimes  beneficial 
in  mercurial  salivation,  but  sometimes  aggra- 
vates it. 

Iodine,  103.  Gargle,  two  drachms  of  tinct.  to 
eight  ozs.  of  water. 


SARCIN.-E. 

Sulphites,  132.  And  hyposulphites  have  been 
employed  to  destroy  sarcinse  and  torulse  in  the 
stomach. 


SCABIES.     {See  Itch.) 


SCARLET  FEVER. 

Aconite,  343.  To  control  accompanying  in- 
flammatory affections.  Should  be  given  if  dur 
ing  convalescence  any  rise  of  temperature  oc- 
curs. 

Arsenic,  3.  With  nitric  acid  in  convalescence  if 
"strawberry"  tongue  persists. 

Belladonna,  394.  Has  been  recommended  as  a 
preventive. 

Cariionate  of  ammonia,  149.  In  three  or  five 
grain  doses  hourly  or  every  two  or  three  hours 
in  al!  forms,  especially  if  given  early. 

Chlorine  water,  99.     In  sloughing  of  throat. 

Cold  afi  usion,  56.  During  first  few  days  when 
skin  hot  and  red. 

Cold  wet  compress  to  throat,  44.  Through- 
out whole  course,  renew  every  three  hours. 

Fat,  238.  Rub  hands  and  feet  with  a  firm  fat  to 
remove  heat  and  tightness  produced  by  rash. 

Some  anoint  whole  body  two  or  three  times  a 
day  with  fat  or  oil,  such  as  almond  oil,  to  pre- 
vent desquamation,  sequelae  and  diffusion  of 
branny  particles  of  the  skin. 

Ice,  68.  Sucking,  in  the  sore  throat,  especially 
at  beginning. 

Ice  poultice,  69.     To  throat. 

Ji*NiPER,  309.  Esteemed  as  a  diuretic  in  scar- 
latinal dropsy. 

Mercury,  198.  The  third  of  a  grain  of  gray 
powder  every  hour  has  marked  effect  on  in- 
flamed tonsils. 

Mustard,  314.  A  general  mustard  bath  on  the 
recession  of  rash  to  bring  it  back. 

Nitric  acid,  125.     Strong   to  sloughs  in  throat. 

Packing,  44.  Throughout  us  course,  especially 
on  recession  of  rash. 

Permang.\nate,  178.    Has  been  given  internally. 


SCARLET   VE\Y.K— continued. 

Salicylic  acid,  451.  And  salicylate  of  soda 
lessen  temperature.     Not  much  used  now. 

Strychnia.  423.  Hypodermically  for  paralysis, 
after  scarlet  fever. 

Sulphate  of  magnesia,  164.  And  other  pur- 
gatives prevent  sore  throat  and  other  sequelae. 

Sulphurous  acid,  131.  Inhalation,  spray  or 
fumigation  in  malignant  sore  throat. 

Veratrum  viride,  328.  Has  been  employed  in 
convulsions. 


SCIATICA. 

AcoN  ite,  339.  As  ointment,  generally  belladonna 
better. 

Act.i-:a,  337. 

Acupi  ncture,  69,  78.  Along  the  course  of  sciatic 
nerve,  often  cures  long-standing  cases. 

Antipyrine,  454.     Internally. 

Atropia,  38-.  Hypodermically,  but  generally 
morphia  better. 

Belladonna,  392. 

Brine  baths,  52.     At  Droitwich  and  at  home. 

Chloride  of  ammonium,  159. 

Chloroform,  276.     Inhalation. 

Counter-irritation,  84.  Free  vesication  by 
cantharides — acupuncture  sometimes  very  ser- 
viceable. 

Ether  6q,  278.  As  spray,  sometimes  removes 
pain  permanently — generally  only  temporarily. 

Galvanism,  69. 

Guaiacum,  336.     Has  been  employed  for  sciatica. 

Iodide  of  potassium,  m.  Sometimes  relieves, 
but  often  fails. 

Methyl  chloride,  278.     As  spray. 

Morphia,  406.  A  single  hypodermic  injection 
sometimes  permanently  cures  long-standing 
cases.  If  not  it  may  be  repeated  every  second 
day  or  so. 

Needle,  84.     On  the  sciatic  nerve. 

Poultices,  64.     Applied  very  hot. 

Salicylate  of  soda,  451. 

Salol   453. 

Sulphur,  92.     Locally. 

Turkish  baths,  59. 

Turpentine,  305.  In  half-ounce  doses  for  four 
or  eight  successive  nights,  has  been  very  suc- 
cessful. 

Veratria,  329.  As  strong  ointment.  Veratrum 
viride  as  tinct.  has  also  been  recommended  (p. 
328). 


SCREAMING  AT  NIGHT.    {See  Night 
Screaming.) 

SCROFULA.     {See  Sores.) 

Blisters,  84.     For  scrofulous  glands. 

Calomel,  191.     As  ointment  for  sores. 

Chloride  of  calcium,  154.  Ten  to  twenty  grain 
doses  in  milk  after  food  when  glandular  en- 
largement of  neck  and  chronic  diarrhoea. 

,  154.  With  glandular  en- 
largements. 

Cod-liver  oil,  242.  Of  great  service  in  the 
various  manifestations  of  this  disease,  as  chronic 
discharge  from  ears  and  nose,  strumous  ophthal- 
mia, strumous  disease  of  bones,  abscesses,  &c. 

Iodine,  102.  Tinct.  or  ointment  applied  over 
scrofulous  glands — take  care  not  to  increase 
inflammation. 

Iron,  176.     Must  be  long  continued. 

Phosphate  of  lime,  156.  Of  great  use  for  scrof- 
ulous sores. 

Soft  soap,  138.  As  application  in  acute  and 
chronic  inflammations,  mesenteric  diseases, 
caries,  and  periostitis,  when  of  a  scrofulous 
nature. 

Sulphides,  g6,  97.  For  sores,  abscesses,  suppu- 
rating glands.     (See  ref.) 


516 


INDEX    TO    DISEASES. 


SCURVY. 

Acms,  129.    Especially  vinegar  to  prevent  scurvy 
in  the  absence  of  lime-juice  or  fresh  vegetables. 
Alcohol,  262.     Diluted  as  a  gargle. 
Atropia,  387.     Hypodermically. 


SEA-SICKNESS.     {See also  Vomiting.) 

Chloral,  284. 

Chloroform,  270.  Drop  doses  of  pure  chloro- 
form. 

Nitrite  OF  AMVL,  296.  Inhalation  for  prevention 
of  sea-sickness.  Internally  for  a  peculiar  affec- 
tion allied  to  sea-sickness. 

Nitro-glycerine,  300. 

Spinal  ice-bag,  71. 


SEMINAL  EMISSIONS.    {See  Sperma- 
tori'hcca.) 

SENILE  DECAY. 

Cod-liver  oil,  235.     With  phosphorus. 
Phosphori;s,  235.     Many  cases  improve. 

SEPTICEMIA.     {See  PycEmia.) 

SEXUAL  DESIRE,  INORDINATE. 

Camphor,  303. 

SHINGLES.     {See  Herpes.) 

SICK  HEADACHE. 

Aconite,  338.  The  ointment  to  be  rubbed  over 
the  painful  brow  at  commencement. 

,  338.      As  ointment   in   neuralgic   sick 

headache. 

Antipyrine,  454.     Highly  useful. 

Bromide  of  potassium^  118.  When  associated 
with  "nervous"  state,  which  it  often  is  at  the 
"  change  of  life." 

• ,290,291.      When   due 

to  uterine  disorder. 

Caffhine,  435.  As  effervescing  citrate  useful  in 
sick  headache. 

Cannabis  indica,  428.  E.specially  valuable  in 
preventing  attacks  when  from  fatigue,  &c., 
they  become  unusually  frequent.  Useful  where 
much  or  little  sickness,  also  sometimes  in  the 
severe  continuous  forms.  One-third  to  half  a 
grain  of  the  extract  at  commencement  of  attack 
will  sometimes  cut  it  short. 

May  be  combined  in  pill  with  iron  or  aloes. 

Chamomile,  456.     A  popular  remedy. 

Chloride  of  ammonium,  159. 

Cocaine,  441.     Internally. 

Croion-chloral,  291.  Especially  in  the  milder 
forms  without  severe  vomiting  and  retching. 
Often  bromide  useful  afterwards. 

• ,  291.  When  the  headache  pre- 
dominates. 

Friedrichshall  water,  161.  A  wineglassful 
in  a  breakfast-cup  of  hot  water  for  bilious  sick 
headache. 

Mercury,  205.     As  blue  pill. 

Nitrite  ok  amyl,  296.     As  inhalation. 

Nitro-glycerine,  300.  A  tablet  every  hour 
immediately  headache  begins.  May  be  given 
in  a  paroxysmal  period — often  successful,  but 
frequently  fails. 

Nux  VOMICA,  420,  421.  A  drop  of  the  tincture 
very  frequently  in  acute  gastric  catarrh  with 
much  headache  and  slight  nausea. 

Phosphorus,  235. 


SICK   W^AXihCYiY.— continued. 

Podophyllum,  335.  When  there  is  either  diar- 
rhcEa  or  constipation,  with  dark-colored  mo- 
tions. If  the  diarrhoea  is  of  a  light  color  the 
hundredth  part  of  a  gram  of  bichloride  of  mer- 
cury three  times  a  day. 

Salicylate  of  soda,  435. 

Valerianate  of  zinc  or  of  ammonia,  310.  In 
two  to  five  gr.  doses  three  times  daily. 

Veratria,  330.  The  ointment  to  be  rubbed  ovei 
the  painful  brow  at  commencement. 

• ,  329.     As  ointment  where  tenderness 

of  skin  present.  It  often  subdues  pain,  pre- 
vents vomiting,  and  shortens  the  attack. 


SICKNESS.     {See   Vomiting.) 

SKIN  AFFECTIONS,  CHRONIC. 

Cod-liver  oil,  242.     When  syphilitic  or  other- 
wise. 


SKIN,  TORPID. 

Acids,    124.      Greatly  diluted    nitric  or  hydro- 
chloric, as  bath. 


SLEEPLESSNESS. 

Alcohol,  267.  In  fevers  if  it  produce  sleep  and 
quell  delirium. 

Bromide  of  p<)Tassium,  118.  Especially  when 
delirium  like  that  of  delirium  tremens  or  ac- 
companying mental  anxiety,  hysteria,  preg- 
nancy, and  general  nervous  irritability.  Dose 
20  to  30  grs.  It  increases  hypnotic  effect  of 
hyosc,  cannabis  ind.,  ether  and  chloroform. 

Cannabis  indica,  428.     Rather  uncertain. 

Chloral,  283.  In  old  people,  delirium  tremens, 
paralysis  of  insane,  acute  mania,  puerperal 
mania,  puerperal  convulsions,  typhus,  phthisis, 
convulsions  of  children. 

CoDEiA,  418.     And  narcein,  both  soporifics. 

Croton-ch LORAL,  292.  One  drachm  may  be 
given. 

Ether,  278.  Or  spirits  of  chloroform  in  a  full 
dose. 

Gelsemium,  382.  In  mania,  drunkards,  and  over- 
excitement. 

HvoscYAMUs,  401.     When  opium  disagrees. 

Morphia,  407.  Hypodermically  injected  in  acute 
mania,  delirium  tremens,  chorea,  &c. 

Opium,  411.  A  rectal  injection  .'-onetimes  suc- 
ceeds best,  e.g.,  for  dyspeptics  or  convalescents 
from  acute  disease,  also  used  in  delirium  tre- 
mens and  traumatic  delirium. 

■ ,  414.     In  fevers. 

,  416.  The  time  of  administration  impor- 
tant— should  be  given  so  as  to  act  at  the  time 
when  the  patient  is  naturally  inclined  to  doze. 

It  should  not  be  given  in  chronic  sleepless- 
ness independent  of  any  very  notable  disease  ; 
chloral  and  bromide  of  potassium  much  better 
in  dyspepsia  and  uterine  derangements. 

Phosphorus,  235.  When  depending  on  cerebral 
anaemia — also  in  the  aged. 

Removal  inland,  42.  When  restlessness  at  night 
is  produced  by  sea-bathing. 

Srrz-MATH,  43.     At  60°  to  So°. 

Tartar-emetic,  214.  In  the  delirium  of  typhus 
and  other  fevers. 

Warm  bath,  51.  Or  sponging,  in  fever  and  con- 
valescence. 

,  51.     In  inflammatory  affections. 


SMALL-POX. 

Collodion,  237.  Or  solutions  of  india-rubber  or 
gutta-percha  in  chloroform  prevent  pitting  in 
small-pox. 


INDEX    TO    DISEASES. 


517 


SMALL-FOX— continued. 

Lime,  152.  Cotton-wool  cut  in  proper  shapes  is 
dipped  into  lime-liniment  and  applied  to  face 
and  neck  to  prevent  pitting. 

Mercury,  197.  Formerly  used  in  ointments  or 
plasters  to  prevent  pittmg. 

Packing,  44.     Especially  on  retrocession  of  rash. 

Silver,  nitk.\te  of,  187.  By  fourth  or  fifth  day 
puncture  vesicles  with  needle  dipped  in  solution 
20  grs.  to  I  oz.,  or  simply  paint  the  skin.  This 
plan  prevents  pitting. 


SNEEZING. 

Arsenic,  217.  A  drop  of  the  liquor  three  times  a 
day  in  paroxysmal  sneezing  allied  to  asthma. 

Camphor,  301.  In  incessant  sneezing  with  pro- 
fuse running  from  eyes  and  nose.  The  powder 
should  be  sniffed  or  the  alcoholic  solution  in- 
haled. 

Iodide  of  potassium,  109.  In  paroxysmal  sneez- 
ing ten  grs.  several  times  a  day. 

Iodine,  log.  Inhalations  in  paroxysmal  sneezing 
with  itching  at  the  nose. 


SOMNAMBULISM. 

Bromide  of  potassium,  119.     In  the  somnambu- 
lism of  children,  which  is  allied  to  epilepsy. 


SORE  FEET. 

Washing  soda,  145.  A  tablespoonful  in  half  a 
gallon  of  wanm  water  as  foot-bath  for  half  an 
hour  in  tenderness  of  soles. 


SORE  NIPPLES.     (See  Nipples,  Sore.) 


SORES.     {See  also  Ulcers.) 

Alcohol,  261.  To  cover  sores  with  thin  protect- 
ing layer  of  coagulated  albumen. 

Alum,  169.  Dry  or  in  solution  to  relaxed  and 
abundantly  secreting  sores. 

Camphor,  301.     For  dusting  on  indolent  sores. 

Carbolic  acid,  257.  Applied  as  stimulant  and 
antiseptic. 

Caustic  alkalies,  134.     Applied  to  hard  edges. 

Charcoal,  66.     Locally  to  sloughing  sores. 

Chloride  of  lime,  66.  Added  to  poultice  for 
offensive  gases. 

Chlorine  solution,  99.  For  sloughing  and  in- 
dolent sores,  as  a. wash. 

Cinchona,  442.  The  powdered  bark  dusted  over 
sloughing  ulcers,  &c. 

Copper,  206.  The  sulphate  as  stick,  solution,  or 
ointment  to  indolent  sores. 

Glycerine  of  carbolic  acid,  247.  A  good  ap- 
plication to  fcetid  sores. 

Hamamei.is,  252.  On  lint  or  cotton-wool  when 
oozing. 

Iodide  of  starch,  66.  Asa  poultice,  cold.  (See 
ref.) 

Iodine,  103.  Sores  of  throat,  syphilitic  and  sim- 
ple. 

Iodoform,  279.  Dusted  over  spreading  or 
sloughing  sores. 

loDOL,  281.  Dusted  over  sores  prevents  suppu- 
ration. Very  useful  in  syphilitic  and  gangren- 
ous sores. 

Lead,  181  The  soluble  salts  as  lotion  to  un- 
healthy over-secreting  sores. 

Lime,  152.  As  carbonate  or  lime-water  to  check 
discharge. 

Mercury,  196.     Calomel  ointment  or  black  wash 
in  scrofulous  or  tubercular  lupus,  and  in  open 
scrofulous  sores. 
Nitric  acid,  124.     To  surface  of  unhealthy  and 
indolent  sores. 


SORE  S — C071  tin  tied. 

Opium,  406.  Or  morphia  with  glycerine  as  an 
application  to  cancerous  or  simple  sores,  to  re- 
lieve pain. 

Phosphate  of  lime,  156. 

Sulphide  of  calcium,  96.  When  thin  ichor 
discharged. 

Tannin,  248.  Or  glycerine  of  tannin  to  coat  over 
wounds  and  profusely  discharging  sores. 

Yeast,  66.     As  poultices,  in  sloughing  sores. 

Zinc,  sulphate  of,  208.  To  unhealthy  free  se- 
creting sores. 


SORE  THROAT. 

of.) 


{See  Throaty  diseases 


SPASMODIC  AFFECTIONS. 

Aconite,  341.     In  spasmodic  laryngitis  rapidly 

produces  good  effects. 
Ammonia.  148.      Useful  in  children's  intestinal 

colic,  &c. 
Camphor,  303. 

Chloroform,  269.    Vapor  in  spasm  of  intestines. 
Hot  sand,  chamomile   flowers  or  tile,  67. 

Locally  in  painful  "spasms." 
Opium,  416.      Very  useful  as  an  antispasmodic, 

especially  if  given  with  a  stimulant,  as  alcohol, 

ether,  or  chloroform. 
Sulpho-carbolates,  259.  In  flatulent  "spasms;' 

sometimes  phosphorus  better. 


SPERMATORRHCEA. 

Belladonna,  394.  A  quarter  grain  of  the  ex- 
tract with  one-and-a-half  grain  zinc  sulphate 
three  or  four  times  a  day,  often  successful  in 
cases  of  nocturnal  seminal  emissions. 

Bladder  to  be  emptied  after  first  deep 
sleep,  120. 

Bromide  of  potassium,  120.  Supplemented  by 
cold  sponging  of  scrotum  and  perinaeum  and 
suspension  of  testes  in  water  ;  use  of  a  hard 
mattress  and  abstention  from  suppers  ;  patient 
to  be  waked  up  after  six  or  seven  hours'  sleep. 

C.\ntharides,  313.  With  iron  internally  in 
emissions. 

Cold  douche,  58.  To  perinseum  and  buttocks 
with  suspension  of  testicles  in  cold  water. 

Cold  sponging,  57. 

Digitalis,  355.  One  or  two  drachm  doses  of  the 
infusion  very  efficacious. 

Hypophosphites,  158.     Of  lime  or  soda. 

Phosphorus,  235.  For  physical  or  mental  de- 
bility induced  by  spermatorrhoea. 

QuiNiA,  448.     Has  been  recommended. 

Spinal  ice-bag,  70. 

Strychnia,  424.  In  large  doses,  especially  when 
associated  with  impotence. 


SPINAL  IRRITATION. 

Aconite,  339.     As  ointment. 

Belladonna,  339.      Preparations  locally  applied 
generally  better  than  those  of  aconite. 


SPRAIN. 

Cold  douche,  57.      Salt   may  be  added.      The 
force  must  be  regulated  by  condition  of  tissues. 


STINGS. 

Ammonia,  147.     Weak  solutions  in  stings  of  in- 
sects to  neutralize  the  formic  acid. 


518 


INDEX    TO    DISEASES. 


STOMACH.   DISEASES  OF.     {See  also 
Vomiting.) 

Acids,  126.  Nitric  or  hydrochloric  in  small  doses 
for  acid  eructations,  heartburn,  and  discomfort 
in  chest  and  epigastrium  due  to  excess  of  acid 
in  stomach. 

Alkahf.s,  139.  In  pain  of  stomach.  Liquor 
potassae  generally  used. 

Am.monia,  14S.  Internally  as  an  excitant  when 
functions  of  stomach  and  upper  intestines  de- 
pressed. 

Arsenic,  222.  A  drop  of  liq.  arsen.  before  food 
in  irritative  dyspepsia,  and  in  vomiting  of 
drunkards.  Useful  in  chronic  ulcer  and  can- 
cer ;  also  in  heartburn  and  gastralgia,  and  in 
chronic  dyspepsia  with  diarrhoea  which  is  ex- 
cited by  food. 

Bellado.v.n.\,  388.     In  some  painful  affections. 

Bismuth  180.  Especially  the  nitrate,  eases  the 
pain  in  both  organic  and  functional  diseases — 
as  cancer,  chronic  ulcers,  chronic  inflammation, 
especially  chronic  gastritis  of  drunkards,  also 
in  gastrodynia  and  cramp  ;  acute  and  chronic 
catarrh  of  stomach  in  children  causing  vomiting 
yield  to  this,  also  the  vanous  forms  of  pyrosis. 

Carbonic  acid  water,  88.  In  painful  and  irri- 
table conditions,  may  be  mixed  with  milk  ;  use- 
ful where  constipation. 

Charcoal,  87.  In  ulcer  of  stomach,  also  in 
neuralgia. 

Chloral,  285.  Sometimes  relieves  pain  of  gas- 
tralgia. 

Chloroform,  270.  Drop  doses  in  flatulent  dis- 
tention, sea-sickness,  and  other  vomitings. 

Cocaine,  441.  In  form  of  pill  averts  vomiting 
and  eases  pain  of  disease  of  stomach. 

CoNiu.M,  364.     Sometimes  relieves  pain  of  cancer. 

Cou.NTER-iKRiT.\TioN,  84.  At  epigastrium  often 
allays  pain  and  obstinate  vomiting  due  to  dis- 
ease of  stomach. 

Cre.\sote,  255.  Checks  pain  after  food,  also 
many  forms  of  vomiting. 

Eucalyptus,  309.  In  chronic  catarrh  and  in 
vomiting  from  sarcinae. 

Glycerine,  248.  3  j  or  3  ij  in  tea,  &c.,  in  flatu- 
lence and  acidity. 

Hydrocyanic  acid.  404.  Much  used  in  painful 
diseases,  as  chronic  ulcer,  cancer,  chronic  gas- 
tritis, gastralgia,  &c.  May  check  vomiting  as 
well  as  relieve  pain. 

Ice-bag,  68.  To  epigastrium,  for  pain  and  vom- 
iting in  cancer,  ulcer,  &c. 

Ikon,  174.  Astringent  preparations  in  haemor- 
rhage from  stomach. 

Lead.  182.  Soluble  preparations  have  been  rec- 
ommended in  pyrosis. 

Li.ME-wATER  AND  MILK.  153.     When  disease. 

Mag.nesia.  151.  As  oxide  and  carbonate — action 
mild — very  suitable  for  children — often  com- 
bined with  rhubarb. 

Bicarbonate,   or.  as  it   is  often   called,  fluid 
magnesia,  is  a  useful  and  mild  aperient. 

Manganese,  178.  Black  oxide  in  gastrodynia 
and  pyrosis. 

Nutrient  e.nemat.^,  77.  In  painful  diseases  as 
chronic  ulcer  and  when  persistent  vomiting. 

Nux  VOMICA,  420.  One  or  two  drops  of  the  tinct. 
every  two  hours  or  oftener  when  tongue  coated 
and  there  is  chronic  catarrh  of  stomach  in  the 
course  of  chronic  disease,  also  when  there  is 
flatulence  and  indigestion,  or  heartburn. 

,  420.     One  drop  every  five  or   ten 

minutes  for  eight  or  ten  doses  in  acute  gastric 
catarrh  with  headache  or  sick  headache. 

Qpiu.M,  410.  Or  morphia,  to  quell  pain  of  many 
stomach  affections,  and  to  relieve  the  vomiting  ; 
thus  it  is  use^l  in  cancer,  chronic  ulcer  and 
chronic  gastritis  from  excessive  indulgence  in 
alcoholic  drinks. 

,  410.     For  the  pain,  nausea,  and  want  of 

appetite  accompanying  alcoholism,  small  doses 
of  morphia  combined  with  tonics  very  effica- 
cious. For  gastrodynia  with  heartburn,  small 
doses  of  morphia  with  bismuth. 


STOMACH,  DISEASES  OY— continued. 

Salicylate  of  .soda,  449.  In  gastralgia  and 
fermentation  in  the  stomach. 

Silver,  nitrate  of,  lop.  Given  in  solution  to 
check  pain  and  vomiting  of  chronic  inflamma- 
tion, chronic  ulcer,  and  even  cancer. 

Strychnia,  419.  Hypodermically  for  gastralgia 
and  gastrodynia. 

Sulphites  and  hyposulphites,  132.  To  destroy 
sarcinae  and  torulae. 

Tannin  250  Sometimes  given  for  irritative 
dyspepsia,  also  in  haemorrhage. 

Turpentine,  304.  In  ha;morrhage  from  chronic 
ulcer,  &c.,  five  to  ten  drops  frequently  repeated. 

Zinc,  sulphate  of,  209.  In  less  than  emetic 
doses  in  painful  affections  due  to  chronic  in- 
flammation of  mucous  membrane. 


STOMATITIS.    {See  Mouth,  diseases  of.) 

Acids,  124.  As  astringents  in  ulcerative  stoma- 
titis ;   others,  however,  are  preferable. 

Alum,  170.  In  ulcerative  stomatitis,  applied  dry 
with  the  finger  many  times  a  day,  especially 
where  disease  affects  one-half  the  jaw. 

Boracic  acid,  133.     As  lotion,  one  in  fifty. 

Chlorate  of  potash,  168.  In  ulcerative  stom- 
atitis. 

Copper,  sulphate  of,  206.  Solution  painted 
over  edges  of  gums  in  ulcerative  stomatitis. 
Generally  dry  alum  better. 

Glycerine  of  tannin,  250.  In  ulcerative  stom- 
atitis. 

Li.me-water,  153. 

Salicylic  acid,  452.  One  part  (dissolved  in  suf- 
ficient alcohol)  to  23o  parts  of  water  eases  pain 
of  catarrhal  stomatitis. 


STONE.      {See  Calculi.) 
STOUTNESS.     {See  Obesity.) 

STRICTURE. 

Opium,  417.     In  spasmodic  stricture. 

STRUMA.     {See  Scrofula.) 

SUNBURN. 
Vaseline  and  petroleum,  253. 

SUNSTROKE. 

Cold  affusion,  57.  When  patient  struck  down 
unconscious. 

SUPPURATION. 

Quinia,  448.  Has  been  recommended  in  profuse 
suppuration. 

Sulphide  of  calcium,  94.  When  ichor  instead 
of  pus  is  secreted.  It  will  also  arrest  suppura- 
tion, or,  if  that  is  impossible,  will  hasten  ma- 
turation. 


ANIMATION        AT 

Cold  water,  37.     Smartly  sprinkled  on  face. 


SUSPENDED 
BIRTH. 


SWALLOWING  LIQUIDS.  CONGEN- 
ITAL DIFFICULTY   IN. 

Bromide    of    potassium,   115.     When  no  diph- 
theria or  malformation. 


INDEX    TO    DISEASES. 


519 


{See    Perspiration^     ex- 


SWEATING. 

cessive. ) 

SYCOSIS. 

Mercury,  193.  Bichloride,  two  grains  to  one 
ounce  of  water  applied  as  lotion  after  each 
epilation. 

,  194.     The  oleate. 

SYNCOPE.     {See  Fainting.) 

SYNOVITIS. 

Blisters,  85.  A  flying  blister  every  night  in 
chronic  synovitis. 

Iodine,  100.  Painted  round  joint  in  chronic 
synovitis. 

Mercury  and  morphi.\,  ole.a.te  of,  193.  Lo- 
cally applied. 

SOFT-SOAH,  138.     Applications. 


SYPHILIS.      {See  Chancre.) 

Cod-liver  oil,  242.     In  chronic  skin  affections. 

Iodide  of  iron,  177.     Where  ansemia. 

Iodide  of  potassium,  ho,  hi.  In  secondary 
and  tertiary  syphilis.  (See  ref.)  Large  doses 
required  for  some  syphilitic  sores.  (Caution, 
p.    II3-) 

loDOL,  281.     In  secondary  syphilis. 

Lamp-bath,  61. 

Mercury,  ho.  For  secondary  syphilis  of  chil- 
dren.    Iodine  sometimes  best. 

,  195.     Corrosive  sublim.  half  an  ounce, 

ammon.  chlor.  one  ounce,  in  a  bath  for  obsti- 
nate rashes. 

,  iq6.  Black  wash  very  useful  in  syphilitic 

sores  generally,  in  mucous  tubercles,  and  in  the 
elevated  indurations,  larger  and  more  irregular 
than  mucous  tubercles,  occurring  near  the  anus 
of  children.  Calomel  or  citrine  ointment  may 
be  substituted  for  black  wash. 

Calomel  dusted  over  condylomata  will  re- 
move them. 

The  cyanide,  ten  to  fifteen  grains  in  an  ounce 
of  water,  may  be  applied  to  rashes  and  sores  on 
throat,  tongue,  penis,  anus,  &c.  For  those  on 
the  prepuce  five  grains  to  the  ounce  quite 
strong  enough.  Should  be  applied  with  soft 
brush  to  chancres,  and  these  should  be  kept 
moist  with  lint  soaked  in  black  wash. 

Mercurial  applications  mixed  with  tar,  &c., 
are  useful  in  syphilitic  psoriasis. 

Mercurial  fumigations,  moist  or  dry,  for  erad- 
icating syphilis.  These  sometimes  produce 
prostration. 

,  196.     Mercurial  and  calomel  ointments 

may  be  rubbed  into  delicate  parts  of  the  skin  to 
mercurialize  the  system. 

Bichloride  has  been  injected  subcutaneously. 
In  syphilitic  ozsena  nitrate  of  mercury  oint- 
ment, partially  melted,  may  be  applied  twice  a 
day  after  nose  well  cleared. 

For  discussion  on  the  use  of  mercury  in 
syphilis,  see  pp.  203,  204. 

,  194.     The  twenty  percent,  ointment  of 

the  oleate  in  the  axilla  useful  for  both  children 
and  adults. 

Nitric  acid,  129.     In  secondary  syphilis. 

Oils  of  mezereon  and  sassafras,  307.  Re- 
ported useful. 

Soft-soap,  138.  Applications  in  glandular  swell- 
ings. 

Zinc,  208.  Chloride,  iodide,  nitrate,  locally  to 
syphilitic  ulcers. 


TEETH,  AFFECTIONS  OF. 

Aconite,  338.  Ointment  or  liniment  for  facial 
neuralgia  due  to  diseased  teeth  ;  will  succeed 
quickly  if  at  all. 


TEETH,  AFFECTIONS  OF— f(w//««f^/. 

Arsenic,  216.     Asescharotic  to  destroy  pulp. 

,  216.     When  for  pain  may  be  mixed  with 

opium.     It  sometimes  at  first  aggravates  pain. 

Bromide  of  potassium,  117.  For  irritability  and 
convulsions  in  teething. 

Capsicum,  316.  A  strong  infusion  applied  on  lint 
for  toothache. 

Chloral,  285.  Rubbed  up  with  equal  weight  of 
camphor  and  rubbed  gently  in  externally  or  put 
into  cavity. 

Chloroform,  270.  Two  or  three  drops  on  cot- 
ton-wool in  ear,  or  into  tooth,  or  hold  over  hol- 
low tooth  a  bit  of  rag  moistened  with  chloro- 
form. 

,  270.      Equal    parts   of   chloroform 

and  creasote  a  good  application. 

Coc.-mne,  440.  1  he  citrate  pressed  into  a  painful 
cavity,  and  before  removing  tartar. 

Collodion',  237.  Mixed  with  crystallized  car- 
bolic acid,  which  has  been  melted  in  a  test-tube, 
may  be  inserted  into  a  tooth  with  exposed  and 
inflamed  pulp  on  cotton-wool :  the  pain  may  be 
at  first  increased  but  is  soon  abolished. 

Creasote,  254.  With  tannin  or  opium  into  hol- 
low of  decayed  tooth  often  gives  relief. 

Croton  chloral,  289.  Sometimes  relieves  tooth- 
ache.    Of  use  if  with  neuralgia. 

Gelsemium,  375,  382.  In  some  forms  of  tooth- 
ache. 

Hot  water,  72.  Rinse  with — sometimes  cold 
better. 

Hyhophosphites,  158.  Of  lime  or  soda  in  teeth- 
ing. 

Iodine,  103.  Tincture  painted  over  gums  close 
to  teeth  when  these  begin  to  recede  and  expose 
teeth.     Also  to  remove  tartar  from  teeth. 

Morphia,  407.  Hypodermically  injected  for 
severe  toothache. 

Opium,  409.  Mixed  with  tannin  or  creasote  and 
inserted  into  the  hollow  of  a  painful  tooth, 
where  inflamed  pulp  exposed. 

Volatile  oils,  306.     In  toothache. 

Zinc,  chloride  of,  208.  To  destroy  exposed 
painful  pulp. 


TETANUS. 

Calabar  bean,  366.  If  possible  by  mouth,  if 
not,  hypodermically  or  by  anus.  It  must  be 
pushed  till  just  short  of  arresting  the  breathing, 
and  should  be  given  at  the  very  beginning. 
The  liquid  extract  is  used. 

Chloral,  2S5.  In  large  doses  has  sometimes 
cured. 

CoNiA,  364.     Hypodermically. 

Ether,  278.  Spray  to  spine  every  two  hours  for 
tetanus. 

Gelsemium,  382. 

NicoTiA,  361.  By  rectum  or  hypodermically, 
appears  to  be  useful  in  many  cases. 

Nitrite  of  amvl,  295.  Inhalation  maybe  tried, 
or  it  may  be  given  subcutaneously. 

Spinal  ice  bag,  71. 


THIRST. 

Acid  drinks,  122.     In  fevers,  promote  secretion 

of  saliva. 
Ice,  68.     Sucking  ice  allays  thirst. 
Tepid  drinks,  72.     in  diabetes. 


THREAD  WORMS.     {See  Worms.) 
THROAT,  DISEASES  OF. 

Aconite,  341.  In  tonsillitis  and  acute  sore 
throat,  when  temperature  high,  drop  cr  half- 
drop  doses  of  the  tincture  every  quarter  of  an 
hour  for  two  hours,  then  every  hour,  will  al- 
most certainly  prove  efficacious. 


520 


INDEX    TO    DISEASES. 


THROAT,    DISEASES    OY—contimu'J. 

Alcohol,  262.  Diluted,  as  gargle  in  relaxed 
throat,  scurvy,  salivation,  &.c. 

Alum,  170.  Dry  or  in  solution,  in  simple  or  scar- 
latinal sore  throat,  in  tonsillitis,  and  even  diph- 
theria. 

Gargles  in  chronic  inflammations,  but  glycer- 
ine of  tannin  better. 

Antimony,  213.  One-quarter  to  one-half  a  grain 
of  tartar-emetic  every  hour  in  tonsillitis. 

Antiseptic  solutions,  99.     In  sloughing. 

Arsenic,  216.  In  medicinal  doses  in  sloughing 
of  throat  or  malignant  sores. 

Belladonna,  388.  Internally  in  severe  inflam- 
matory diseases,  especially  when  throat  and 
tonsils  acutely  inflamed  and  much  swollen — 
may  be  given  with  aconite. 

Capsiclm,  316.  One  drachm  of  the  tinct.  to  half 
a  pint  of  water  as  a  gargle  in  some  sore  throats, 
and  in  the  very  early  stage  of  tonsillitis  and 
pharyngitis,  also  in  malignant  sore  throat  and 
in  relaxed  throat. 

Carbolic,  258.  Spray  to  nose  or  gargle  in  con- 
tagious sore  throat. 

Cocaine,  430.  Painting  with  a  20  per  cent,  solu- 
tion in  ulcerations  of  epiglottis.  A  4  per  cent, 
solution  in  tonsillitis  rapeated  every  hour  re- 
lieves pain.      Sometimes  as  spray. 

Cold  compress,  342.  Used  nightly  to  harden 
throat,  when  tendency  to  catarrh.  It  should 
be  swabbed  daily  with  glycerine  of  tannin. 
Inhalations  of  sulphurous  or  carbolic  acid 
useful. 

Creasote,  254.  Or  carbolic  acid  gargle  in  sloughs 
of  throat. 

Glycerine  of  tannin,  250.  After  acute  inflam- 
mation ;  in  ulceration  in  aphthous  sore  throat ; 
in  chronic  inflammation  ;  often  when  accom- 
panied by  deafness  or  cough,  provided  no  ca- 
tarrh or  phthisis  or  teething  irritation. 

Guaiacum  lozenges,  336.  In  follicular  pharyn- 
gitis. 

Ice,  68.  Very  valuable,  constantly  sucked  in 
tonsillitis,  sore  throat,  &c. 

,  69.  A  poultice  of  broken  ice  in  an  india- 
rubber  bag  in  tonsillitis,  scarlet  fever  and  diph- 
theria, especially  when  lymphatic  glands  much 
swollen. 

Iodine,  103.  Tincture  injected  into  hypertro- 
phied  tonsils. 

,  104.      Tincture  applied  locally  to  sores, 

whether  syphilitic  or  not. 

Ipecacuanha  wink,  325.  As  spray  in  non-inflam- 
matory sore  throat  and  hoarseness  from  conges- 
tion of  vocal  cords. 

Mercury,  198.  In  acute  tonsillitis  when  tonsils 
almost  meet,  the  third  of  a  grain  of  gray  pow- 
der every  hour  benehcial  even  if  an  abscess  has 
formed. 

Mercury  and  morphi.\.  oleate  op-,  194.  In 
obstinate  and  painful  ttmsillitis. 

Nitrate  op"  potash,  166.  Crystals  sometimes 
sucked  in  acute  inflammation,  but  other  reme- 
dies preferable. 

Nitrate  of  silver,  189.  In  'early  stage  of  in- 
flammation locally  applied  may  cut  it  short. 
Solutions  are  used  in  chronic  sore  throat,  but 
generally  tannin  and  other  astringent  but  non- 
irritant  applications  better  unless  in  a  sloughing 
condition.  Sometimes  used  in  diphtheria  on 
inflamed  patches  only.  Sometimes  applied  to 
chronically  inflamed  larynx,  as  in  phthisis,  by 
brush  or  spray. 

Sometimes  injected  into  trachea  in  asthma, 
bronchitis  and  phthisis  (see  p.  189). 

Nitric  acid,  124.  Applied  undiluted  to  foul 
sloughs. 

Salicylate  of  soda,  452.  Extremely  successful 
in  quinsy. 

Sulphides,  94.  As  natural  waters,  especially 
useful  in  follicular  pharyngi'is. 

Sulphurous  acid,  131.  Inhalation,  spray,  or 
fumigation,  for  malignant  sore  throat,  whether 
scarlatinal  or  otherwise. 


THROAT,    DISEASES    OY— continued. 

Tannin,  250.     A  spray  of   five   per  cent,  tannin 

in  diphtheria  and  croup. 
Zinc,  sulphate  of,  208.     As  gargle  occasionally 

employed  in  relaxed  throat. 


THRUSH. 

Borax,    133.       With    honey   or  as  glycerine   of 

borax. 
Copper,  sulphate  of,  206.     A  weak  solution  to 

be  painted  over  mucous  membrane. 
Glycerine,  247.     Will  sometimes  cure. 
Glycerine  of  borax,  247. 
Salicylic    acid,   452.      One   part   (dissolved   in 

alcohol)  to  250  of  water. 
Sulphurous   acid,  131.     As  solution,  strong  or 

diluted,  locally  applied. 


TIC.     {See  A^euralgia.) 


TINEA  FAVUS. 

Mercury,  193.  A  lotion  of  two  grains  of  the  bi- 
chloride in  an  oz.  of  water  applied  after  each 
epilation. 

,  194.     As  oleate,  see  Tinea  sycosis. 

Oils,  238.  To  facilitate  removal  of  scabs — poul- 
tices used  also  preparatory  to  epilation. 

,  238.     Head  to  be  greased  freely  to  prevent 

spreading.  Other  members  of  family  should 
also  grease  freely.  A  mild  mercurial  pomade 
or  quinine  in  glycerine  best. 

Sulphurous  acid,  131.  The  Pharmacopoeia  acid 
with  glycerine.  If  the  case  is  obstinate  epila- 
tion assists. 


TINEA  SYCOSIS. 

Mercury,  193.  A  lotion  containing  two  grains 
of  the  bichloride  to  an  ounce  of  water  to  be  ap- 
plied after  each  epilation. 

,  194.     The   five   per  cent,  solution   of 

oleate  in  oleic  acid  with  the  addition  of  an 
eighth  part  of  ether. 


TINEA  TARSI. 

Blisters,  83.  To  temple,  frequently  repeated 
in  obstinate  cases. 

Mercury,  193.  The  irritant  ointments.  Eye- 
lashes to  be  cut  short  and  ointment  applied 
night  and  morning  after  picking  off  scabs. 
Ung.  hydrag.  nit.  should  not  be  diluted  to  more 
than  half  its  strength.  Sometimes  best  un- 
diluted. 

,  194.     As  oleate,  see  Tinea  sycosis. 

Silver,  nitrate  of,  189.  Solid  in  obstinate  cases 
after  removal  of  scabs. 

Sulphate  of  copper,  206.  As  nitrate  of  silver, 
but  milder. 


TINEA  TONSURANS. 

Acetic  acid,  123.     Strong,  locally. 

Croton  oil,  245.     Liniment  applied  with  brush, 

followed  by  poultice. 
Iodine,  ioi.     Two  drachms  with  an  oz.  of  oil  of 

wood  tar,  as  a  local  application. 
Glycerine  of  carbolic    acid,   258.      In   early 

stages. 
Mercury,  193.     For  lotion,  see  Tinea  favus. 

,  194.     As  oleate,  see  Tinea  sycosis. 

Oils,  238.     See  Tinea  favus. 

SuLPHO-CYANiDR    OF   POTASSIUM,  404.     Half  an 

ounce  with  one  oz.  glycerine  and  seven  ozs.  of 

water  as  lotion.     (See  ref.) 


INDEX    TO    DISEASES. 


521 


TINEA  TONSURANS— r«?«//««<^d'. 

Sulphurous  acid,  131.     See  Tinea  favus. 
Turpentine.   303.      Followed  by   iodine.      (See 
ref.) 


TOE-NAIL,  INGROWING. 

PoTASSA,  136.  Cotton-wool  kept  moist  with 
liquor  potassae  pressed  down  between  nail  and 
soft  parts. 


{See    Throat,   diseases 


{See    Teeth,   affections 


TONSILLITIS. 

of.) 

TOOTHACHE. 

of-) 

TORTICOLLIS. 

Capsicum,  316.  A  handful  of  the  crushed  pods 
are  infused  for  36  hours  in  a  pint  of  hot  or  cold 
water  and  applied  on  lint  covered  with  gutta- 
percha. 

TORUL.E,     {See  Sarcince.) 

TUBERCULOSIS.     {See  Phthisis.) 

Arsenic,  231.  Appears  to  reduce  temperature, 
and  is  perhaps  beneficial  in  many  ways. 


TUMORS. 

Chloroform,  276.      In   diagnosis  of  abdominal 
tumors,  also  in  that  of  phantom  tumors. 


TYMPANUM,  RUPTURE    OF. 
£ar,  diseases  of.) 


{See 


TYPHLITIS. 

Ice  poultice,  t 
of  abdomen. 

Chloral,   283. 
Opium  beiter. 


!.     To  right  side  of   lower  part 
Often   employed    for  typhoid. 


TYPHOID  FEVER.     {See  also  Fevers.) 

Alum,  171.     For  the  diarrhoea. 

Cold  affusion,  see  p.  47. 

Cold  compresses  ok  packing.  47. 

Digitalis,  355.  Recommended  by  Wunderlich 
to  lower  temperature  and  slacken  pulse. 

Ergot,  430.  For  intestinal  haemorrhage — hypo- 
dermically  if  urgent. 

Hydrochloric  acid,  129. 

Ice  poultice,  68.  To  right  side  of  lower  part 
of  abdomen. 

Lead,  183.  The  acetate  with  opium  for  the 
purging. 

Mercury,  202.  Corrosive  sublimate,  the  hun- 
dredth of  a  grain  every  two  or  three  hours  for 
the  diarrhoea. 

,  205,  206.      Calomel,  in  small  doses  at 

commencement,  not  to  be  pushed  so  as  to  touch 
the  gums. 

Opium,  410.  In  small  doses  at  night  for  wake- 
fulness with  delirium,  and  also  for  the  diar- 
rhoea. 

,411.  May  be  given  as  injection  for  diar- 
rhoea. 


TYPHOID  Y'EX'EK—contimted. 

QuiNiA,  446.     To  reduce  temperature. 

Salol,  453. 

Sulphurous  acid,  131. 

Turpentine,  304.  In  five  to  ten  drop  doses  fre- 
quently repeated  for  haemorrhages ;  and  in  ten 
min.  doses  every  two  hours  in  the  advanced 
si  age  with  a  dry  tongue,  or  drachm  doses  every 
six  hours  may  be  given  when  tympanitis  and 
prostration  but  without  diarrhoea.  (See  also 
p.  2) 

Veratrum  viride,  328.     Has  been  employed. 


TYPHUS  FEVER.     {See  also  Fevers.) 

Antimony,  213.  In  the  delirium  with  wakeful- 
ness—tartar-emetic  combined  with  opium.  (See 
Fever.) 

Belladonna,  388.  Said  to  clean  the  tongue. 
(See  also  p.  394.) 

Chloral,  283.  To  produce  sleep  and  allay  vio- 
lent delirium. 

Cold  affusion,  48. 

QuiNiA,  446.     To  reduce  temperature. 


ULCERS.     {See  also  Sores.) 

Chlorate  of  potash,  168.  In  solution  as  a  wash 
to  clean  and  stimulate  foul  ulcers — other  reme- 
dies better. 

Cinchona,  442.  The  powdered  bark  dusted  over 
foul,  indolent,  sloughing  and  gangrenous  ulcers 
promotes  the  healing  process. 

CoNiUM,  362.  Locally  applied  by  means  of  a 
poultice,  will  ease  the  pain  and  improve  the 
character  of  the  sore. 

Glycerine  of  tannin,  248.     If  not  sloughing. 

Nitric  acid,  124.  Locally  to  destroy  foul,  un- 
healthy surface.  As  lotion  to  indolent  and 
painful  ulcers. 

Silver,  nitrate  of,  189.  .Applied  to  unhealthy 
ulcers.     Also  to  ulcers  of  mouth. 


URETHRITIS. 

Boro-glyceride,  133.     As  injection. 

URIC  ACID,  EXCESS  OF,  IN  URINE. 

Alkalies,  140.     Citrates  are  best. 

URINE,   INCONTINENCE   OF.     {See 
Incontinence.) 

URINE,  SUPPRESSION  OF. 

Copious  injections,  76.   Beneficial  in  some  cases. 

URTICARIA. 

Alkalies,  134.     (See  Pruritus.) 
Benzoic  acid,  307.     In  eau  de  Cologne. 
Benzoin,  307.     The  comp.  tinct.  painted  on  the 

skin  for  itching. 
Chloroform,  269.     As  ointment  to  allay  itching. 
Colchicum,  332.     In  gouty  persons. 
Cv.anide    of    potassium,  403.      Or  hydrocyanic 

acid.     (See  Itching.) 
Lead,  182.     Lotions  to  ease  itching. 
Nitric  acid,  124.    A  dilute  wash  controls  itching 

and  prevents  wheals. 

\V.\RM    baths,  51. 

UTERINE  DISEASES. 

AcTyEA  racemosa,  337.    To  prevent  miscarriages 
in  irritable  uterus  and  prolapsus. 


522 


INDEX    TO    DISEASES. 


UTERINE  DISEASES— r<w//;;«.<?'. 

Belladonna,  387.  With  tannin  as  suppository 
in  neuralgia  of  uterus. 

Camphor,  302.  A  saturated  solution  in  eau  de 
Cologne  to  be  rubbed  into  the  head  for  drowsi- 
ness or  headache  of  uterine  origin. 

Carbolic  .\cid,  258.  A  wealc  solution  as  injection 
in  cancer,  &c. 

,  259,  260.     Pure  in  ulcer  of  os  and 

cervix  and  chronic  inflammation  of  uterus  or 
cervix.     (See  ref.) 

Carbonic  acid  g.-iS,  8S.  Injected  up  vagina  for 
pain  of  ulceration  of  os,  cancer  and  neuralgia 
of  uterus. 

Caustic  lime,  152.  Mixed  with  caustic  potash 
as  escharotic  in  affections  of  neck  of  uterus. 

Chloroform,  269.  As  spray  in  cancer,  ulceration 
of  OS,  and  neuralgia,  must  be  continued  some 
minutes. 

Ergot,  430.     Hypodermically  for  fibrous  tumor. 

,  431.     The  most  valuable  medicine  known 

for  uterine  haemorrhage — must  be  given  in  full 
doses  and  repeated  every  hour  or  so.  Dry  cup- 
ding  over  the  sacrum  useful,  perfect  rest  nec- 
essary. 

Glycerine,  247.  In  congested  neck  of  womb  a 
pledget  of  cotton-wool  saturated  with  glycerine 
and  applied  for  several  hours  will  induce  a  co- 
pious discharge  of  serum  which  will  give  as 
much  relief  as  leeches, — a  piece  of  twine  should 
be  fastened  to  it. 

Glycerine  of  tannin,  251.  Checks  discharge 
and  stench  of  cancer,  better  still  if  mixed  with 
glycerine  of  carbolic  acid. 

Iodoform,  279.  As  bolus  with  cocoa  fat  inserted 
into  excavation  produced  by  cancer. 

Iron,  178.     Locally  in  uterine  catarrh. 

Lead,  182.  As  plaster  for  pain  in  back  due  to 
uterine  disease. 

Opium,  411.  An  injection  into  the  rectum  of 
laudanum  and  starch  will  subdue  the  pain  of 
uterine  diseases. 


VACCINATION. 

Aconite,  344.  For  erysipelatous  redness  after 
vaccination.  This  treatment  may  be  supple- 
mented by  the  local  application  twice  daily  of 

•    belladonna  ointment. 


VAGINA,   DISEASES  OF. 
T/iiis. ) 


{See    Vul- 


Boro-glyceride,  133.     As  injection  in  vaginitis. 

Cocaine,  440.  Suppositories  and  pessaries  in 
painful  conditions.  A  lotion  relieves  vaginis- 
mus. 

Glycerine  of  tannin,  249.  In  chronic  vagin- 
itis of  children. 


VARICOCELE. 

Cold  douche,  59.     To  perinaeura  and  buttocks, 

with  suspension  of  testicles  in  cold  water. 
Hamamelis,  252. 


VERTIGO,  AURAL. 

Gelsemium,  382.     The  tincture  in  10  min.  doses 
thrice  daily. 


VOMITING. 

Acids,  126. 

Alum,  171.  In  six  to  ten  gr.  doses  in  obstinate 
vomiting  of  phthisical  patients  excited  by  cough- 
ing. 


VOMITING— r()////«?/^^/. 

Arsenic,  222.  One  drop  of  liq.  arsen.  before 
food  in  vomiting  of  drunkards,  also  in  chronic 
vomiting  without  pain  or  nausea,  has  been  rec- 
ommended in  vomiting  of  cholera. 

Bicarbonate  of  soda,  153.  Half-drachm  to  a 
drachm  to  a  pint  of  milk  for  infants,  especially 
if  constipated.  If  lime-water  and  bicarbonate 
of  soda  both  fail,  stop  all  milk  and  feed  on  sop- 
ped bread,  water  gruel  and  chicken  or  veal 
broth. 

Bismuth,  180.  In  many  forms  of  vomiting  in 
children,  especially  when  due  to  acute  or  chron- 
ic catarrh  of  the  stomach. 

Carbonic  acid  water,  88.     With  milk. 

Chlor.i^l,  284.     In  pregnancy. 

Chloroform,  270.  In  drop  doses,  pure,  in  sea- 
sickness and  other  vomiting. 

Counter-irritation,  84.  At  epigastrium  often 
allays  pain  and  obstinate  vomiting  due  to  dis- 
eases of  the  stomach. 

Creasoi  E,  255.  In  sea-sickness,  pregnancy,  can- 
cer, ulcer  of  stomach,  and  Hright's  disease. 

Eucalyptus,  309.     When  sarcinae. 

Gelatine,  153,  154.  With  milk,  cream,  and  ar- 
rowroot, as  food  for  young  children.     (See  ref.) 

Hydrocyanic  acid,  404.  Sometimes  checks  vom- 
iting as  well  as  relieves  the  pain  of  chronic  ul- 
cer, cancer,  chronic  gastritis,  gastralgia,  &c. 

Ice-bag,  68.  To  epigastrium  for  pain  and  vom- 
iting of  cancer,  &c. 

Ipecacuanha,  151.     In  sympathetic  vomiting. 

■ ,326.      In    pregnancy   (see   ref.),  at 

menstrual  times,  in  the  morning  vomiting  of 
drunkards,  but  here  arsenic  generally  better. 
In  morning  vomiting  from  weakness,  and  in 
convalescents,  in  acute  catarrh  of  the  stomach 
in  children — may  be  combined  with  aconite  if 
inflammation  great,  in  whooping  cough — here 
sometimes  alum  better.  In  the  vomiting  oc- 
curring without  nausea  immediately  after  meals 
— here  arsenic  better. 

Lime-water,  153.  In  chronic  forms,  as  from 
chronic  ulcer,  mixed  with  milk — if  vomiting  in- 
cessant, patient  should  be  fed  on  this  only  in 
frequent  small  quantities.  Milk  with  one-eighth 
of  lime-water  often  sufficient  for  infants  in 
■whom  the  gastric  juice  coagulates  milk  causing 
vomiting,  wind  and  colic.  If  they  are  consti- 
pated bicarb,  of  soda  better.     (See  above.) 

Magnesia,  151.  In  sympathetic  vomiting — ef- 
fects very  transient. 

Mercury,  ig8.  As  calomel,  or,  better  still,  gray 
powder,  one-third  grain  every  two  hours  in  the 
sudden  forcible  vomiting  of  children.  Small 
doses  frequently  given  are  useful  when  vomit- 
ingaccompanied  by  clayey  stools. 

Morphia,  408.  Hypodermically  in  pregnancy  as 
well  as  other  severe  forms.  Often  arrests  per- 
sistent hiccup. 

NiTRO-GLYCERINE,  300. 

Nutrient  enemata,  77.  In  persistent  vomit- 
ing. 

Nux  vomica,  318.  When  tongue  coated  with 
thick  fur — may  be  given  with  ipecac. 

Oxalate  of  cerium,  151.  One  grain  ever^-  three 
hours  in  sympathetic  vomiting. 

QuiNiA,  151.     In  sympathetic  vomiting. 

,  447.     Sometimes  useful   in  vomiting  of 

pregnancy. 

Spinal  ice-bag,  71.  In  pregnancy  and  sea- 
sickness. 

Veratrum  album,  32S.  In  vomiting  andjpurg- 
ing  of  summer  diarrhoea. 


VULVITIS. 

Alum,  170.  A  lotion,  or  if  inflammation  higher 
up  an  injection,  of  sixty  grains  to  a  pint  of 
water,  to  be  used  every  hour  or  oftener.  The 
strength  is  occasionally  too  much. 

Glycerine  of  tannin,  249.  In  chronic  vaginitis 
of  children. 


A 


INDEX    TO    DISEASES. 


523 


VXJhVITlS—coniinm'i/. 

Lead,  182.  Solutions  of  the  acetate  or  diacetate 
as  wash  when  acute  stage  just  subsided — later 
on  stronger  astringents  needed. 

Lime-water,  152.     As  a  wash. 


WARTS: 

Arsenic,  215.  Arsenious  acid  as  a  caustic — 
enough  to  be  used  to  excite  active  inflamma- 
tion.    (See  ref.) 

,  216.     Liquor  arsenicalis  may  be  painted 

over  warts. 

Caustic  alkalies,  134.  Undiluted  or  mixed 
with  caustic  lime,  locally. 

Chromic  acid,  132.  A  solution  of  100  grs.  to  one 
OE.,  applied  with  a  glass  rod  so  as  just  to  satu- 
rate the  diseased  growth,  any  superfluous  acid 
to  be  removed  ;   dress  with  dry  lint. 

Glacial  acetic  acid,  123.     Very  effectual. 

Mercury,  nitrate  ok,  igi.     Locally  applied. 

Nitric  acid,  124.  A  drachm  or  two  of  the  dil. 
acid  to  a  pint  of  water,  as  a  wash  to  keep  small 
syphilitic  wartF  and  condylomata  constantly 
moist. 

Salicylic  acid,  452. 

Silver,  nitrate  of,  187.  As  caustic,  but  too 
superficial. 

Zinc,  208.     Chloride,  iodide  and  nitrate  locally. 


WASTING   DISEASES. 

Phosphate  of  lime,  156.     In  chronic  cases. 

WHEEZING. 

Arsenic,  226.  In  emphysematous  persons — 
(see  Emphysema).  In  the  wheezing  of  children 
with  oppressed  breathing. 

WHITE   SWELLING. 

Iodine,  102.     A  solution  injected  into  the  joint. 

WHITLOW. 

Antimony,  213.  As  tartar-emetic.  (See  Inflam- 
mation.) 

Carbolic  acid,  257.  To  benumb  the  surface 
during  incision. 

WHOOPING-COUGH. 

Alum,  172.  When  acute  stage  is  over  and  there 
is  no  complication,  two  to  six  grs.  every  three 
hours,  or  less  every  hour  in  glycerine  or  honey. 

Belladonn.^,  393.  Especially  during  third  week. 
Children  bear  this  drug  well ;  ten  minims  of  the 
tinct.  may  be  given  hourly  to  a  child  two  or 
three  years  old. 

Of  little  use  if  complications  exist. 

Bromide  of  potassium,  114.  Especially  in  sum- 
mer. When  uncomplicated,  except  with  con- 
vulsions. 

Cannabis  indica,  429.     Has  been  found  useful. 

Carbo.nate  of  potash,  142.  In  one  or  two  grain 
doses. 

Chloride  of  ammonium,  159. 

Chloroform,  269.  Or  ether,  to  lessen  violence 
of  paroxysms. 

Clover,  ^27.  A  wineglassful  occasionally 
through  the  day  of  an  infusion  made  of  two 
ounces  of  carefully  dried  red  blossoms  steeped 
in  a  pint  of  boiling  water  for  four  hours. 

Cod-liver  oil,   243.     In  middle  and  after  stage. 

CONIUM,  364. 

Ergot,  431.     Said  to  be  useful. 
Ipecacuanha,  326.     Useful  in  many  cases. 


WHOOPING-COUGH— f^'^Z/wM^a'. 

Lime-water,  154.  Useful  from  its  astringency, 
as  in  some  forms  alum  and  tannin  advantageous. 

Lobelia,  427.  In  spasmodic  stages.  Children 
very  tolerant  of  this  drug  ;  for  a  child  two  years 
old,  ten  min.  of  the  tinct.  every  hour  and  an 
additional  dose  each  time  the  cough  is  immi- 
nent, provided  the  paroxysm  gives  sufficient 
warning. 

Musk,  260.     Has  been  given. 

Musi  AKD,  315.     Said  to  be  useful. 

Opium,  416.  In  convulsive  stage.  Sufficient 
should  be  given  to  produce  slight  heaviness, 
which  should  be  maintained.     (See  ref.) 

Sbnega,  463.     Given  by  some. 

Silver,  nitr.\te  of,  189.  A  solution  for  spong- 
ing out  throat  or  as  spray.  As  spray  when  pa- 
tient more  than  two  or  three  years  old. 

Tannin,  250.     Applied  to  throat. 

Valerian,  310.  Preparations  said  to  control 
paro.\ysras. 

Zinc,  209.     As  oxide  or  sulphate. 


WORMS. 

Alum,  466.     As  solution  for  injection. 

Areca  nut,  465.     For  tape  worm. 

Bromide   of   potassium,    117.       In   convulsions 

caused  by  worms. 
Chioride    of    a.mmonium,    159.        To    prevent 

formation  of  thick  mucus  which  serves  as  nidus 

for  worms. 
Chloroform,  277.     For  tape  worm. 
Common  salt,  465.     Chloride  of  ammonium  and 

antimony  to  remove  catarrhal  state  of  mucous 

membrane. 
EucALVPTOL,  309.     Injection  for  thread  worms. 
FiLix  MAS,  463.     For  tape  worm,  to  be  taken  on 

an  empty  stomach  and   followed   by   a   purge. 

(See  ref.  for  directions.) 
Injections,  76.      For    thread    worms  ;     enough 

liquid   should  be  used  to  reach  a  little  higher 

than  the  rectum.     Half  a  pint  enough  for  an 

adult.     Solution  of  salt,  iron,  &c.,  mu!-t  not  be 

too  concentrated  lest  inflammation  ensue. 
Iron,  174.     Tinct.  ferr.  sesquichlor.  half  an  ounce 

in  a  pint  of  water,  a  good  injection  for  thread 

worms,  coagulating  albumen. 
Kamela,  465.  For  tape  worm. 
Kousso,  464.  For  tape  worm. 
Lime-water,    154  and   466.        As  injection    for 

thread  worms. 
Oils,  466.     Reputed  vermicides. 
Pelletierine,    464.        The    tannate    in     tape 

worms. 
PuNiCA  gran.a.tum,  464.      As  infusion   for  tape 

worms. 
Quassia,  456.     The  infusion  useful  for  ascarides, 

as  injection  or  by  mouth. 
Santonin,  464.     For  round  and  thread  worms,  in 

castor  oil  by  mouth  or  as  an  injection   or   sup- 
pository. 
ScAMMONY,  460.      For  thread  worms   in   the  rec- 
tum. 
Tannin,  250.     As  catechu,   kino,  red   gum,   rha- 

tany,  ha;matoxylum,  in   injections   to   destroy 

thread  worms. 
Tonics,  466.     As  cod  liver  oil  and  iron  to  restore 

intestinal  canal  to  healthy  condition. 
TuRPENTi.NE,  304.     As  poison  to  tape  and  thread 

worms.     (See  also  p.  465.) 
Valerian,  310.     Especially  when  convulsions. 


WOUNDS. 

Aloes,  457.  Topically  as  a  slight  stimulant— of- 
ten purges. 

Carbolic  acid,  257.     Locally. 

Collodion,  238.  Paint  over  to  adjust  edges  and 
exclude  air. 


524 


INDEX    TO    DISEASES. 


\\0\]'SD^—conlinued. 


On  lint  or  cotton-wool   when 
Applied  to  wound  prevents 


Hamamelis,  252 
oozing. 

Ice  and  salt,  6i 
inflammation. 

Iodoform,  279. 

loDOL,  281.     Cleans  gangrenous  wounds. 

Opium,  411.     To  quiet  intestinal   movements   in 
wounds  of  the  abdomen. 

Sui.PHUKOus  ACID,  131.     Solution  constantly  ap- 
plied, diluted  or  not. 

Tannin,  248.     Or  glycerine  of  tannin  to  coat  over 
wounds. 


WOUND  S— con  tin  ued. 

Turkish  bath,  59.     For  pain  in  the  seat  of  old 
wounds. 


XERODERMA. 

Glycerine,  247.  Glycerine  of  starch  to  be  rub- 
bed in  daily  after  a  bath. 

Oils  and  fats,  238.  In  conjunction  with  warm 
baths  to  lubricate  skin. 

Vaseline  and  petroleum,  253. 


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